Provider Demographics
NPI:1447235411
Name:UROLOGY ASSOC. OF N.E. FLORIDA
Entity Type:Organization
Organization Name:UROLOGY ASSOC. OF N.E. FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:H
Authorized Official - Last Name:BLASSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-264-8418
Mailing Address - Street 1:1715 VILLAGE WAY
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-5263
Mailing Address - Country:US
Mailing Address - Phone:904-264-8418
Mailing Address - Fax:
Practice Address - Street 1:1715 VILLAGE WAY
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5263
Practice Address - Country:US
Practice Address - Phone:904-264-8418
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-13
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0023670208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD50003Medicare UPIN
FL1322890001Medicare NSC
FL45116Medicare ID - Type UnspecifiedPA MEDICARE NUMBER