Provider Demographics
NPI:1952388100
Name:BLECKER, EDGAR R (MD)
Entity Type:Individual
Prefix:
First Name:EDGAR
Middle Name:R
Last Name:BLECKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 PINEHURST DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-3833
Mailing Address - Country:US
Mailing Address - Phone:352-277-5348
Mailing Address - Fax:352-606-2857
Practice Address - Street 1:13090 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3733
Practice Address - Country:US
Practice Address - Phone:772-589-3755
Practice Address - Fax:772-589-2315
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME78368207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL35392OtherBC&BS PROVIDER #
FLH02783Medicare UPIN
FLDB1340Medicare ID - Type UnspecifiedGROUP # RAILROAD CARRIER
FLE2997WMedicare PIN
FL35392OtherBC&BS PROVIDER #