Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | ME145484 | FL |
N | 207YS0123X | Facial Plastic Surgeon | ME145484 | FL |
NPI | 1407275829 |
---|---|
Provider Name | Dr. Elizabeth Anne Blasberg |
First Address | Fort Pierce, FL 34981-5057 |
Second Address | Fort Pierce, FL 34981-5057 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2014 |
Last Update Date | 08/06/2020 |