Provider Demographics
NPI:1265428700
Name:BLOCKER, DAVID EDWARD (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EDWARD
Last Name:BLOCKER
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1087
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-8087
Mailing Address - Country:US
Mailing Address - Phone:609-784-2770
Mailing Address - Fax:
Practice Address - Street 1:1308 PALUXY RD STE 204
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-5689
Practice Address - Country:US
Practice Address - Phone:817-579-9357
Practice Address - Fax:817-579-9363
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK26512083P0901X, 207R00000X, 207R00000X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX386974507Medicaid
TX386974505Medicaid
TX386974505Medicaid