Provider Demographics
NPI:1164760187
Name:BLOCH, EDWARD JEFFREY (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:JEFFREY
Last Name:BLOCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13764 MONACO WAY
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-1235
Mailing Address - Country:US
Mailing Address - Phone:561-691-9835
Mailing Address - Fax:561-691-9836
Practice Address - Street 1:13764 MONACO WAY
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-1235
Practice Address - Country:US
Practice Address - Phone:561-691-9835
Practice Address - Fax:561-691-9836
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16781207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery