Provider Demographics
NPI:1104186808
Name:BLESSING, NATHAN WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:WAYNE
Last Name:BLESSING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7101 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33418-3701
Mailing Address - Country:US
Mailing Address - Phone:561-355-8663
Mailing Address - Fax:561-355-8618
Practice Address - Street 1:7101 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33418-3701
Practice Address - Country:US
Practice Address - Phone:561-355-8663
Practice Address - Fax:561-355-8618
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME127118207WX0200X, 207W00000X, 207WX0200X
OK29220207WX0200X
FLTRN18554390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200443780BMedicaid