Blossom, Eddye

Blossom, Eddye is an individual health care provider with primary practice located at 4864 Jackson St , Monroe LA 71202-6400. He recently has only one registered license in Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, which is considered as his primary health care specialty. Blossom, Eddye can be contacted via phone (318) 330-7626.

Contact Information

Primary practice address
4864 Jackson St Monroe LA 71202-6400
Phone: (318) 330-7626
Fax: (318) 330-7648
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X MD.204270 Louisiana
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X 45438 Tennessee
Allopathic & Osteopathic Physicians / Obstetrics & Gynecology 207V00000X E-6247 Arkansas

Profile Details

NPI number 1003028762
LBN Legal business name Blossom, Eddye
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 4th, 2007
Last updated Jan 24th, 2013 - about 11 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1003028762 NPPES
Louisiana MEDICAID 2138014

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