Blossom, Benjamin David
Blossom, Benjamin David is an individual health care provider with primary practice located at 499 Gloster Creek Vlg Suite A-2, Tupelo MS 38801-4600. He recently has only one registered license in Allopathic & Osteopathic Physicians / Cardiovascular Disease, which is considered as his primary health care specialty. Blossom, Benjamin David can be contacted via phone (662) 620-6992.Contact Information
Primary practice address
499 Gloster Creek Vlg Suite A-2
Tupelo MS 38801-4600
Phone: (662) 620-6992
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Cardiovascular Disease | 207RC0000X | 19111 | Mississippi |
Profile Details
| NPI number | 1477648087 |
|---|---|
| LBN Legal business name | Blossom, Benjamin David |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 3rd, 2006 |
| Last updated | Jun 28th, 2011 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1477648087 | NPPES |
| Mississippi | MEDICAID | 03670007 |
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