Provider Demographics
NPI:1871528562
Name:EDGAR R BLECKER MD PA
Entity type:Organization
Organization Name:EDGAR R BLECKER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:BLECKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-581-0016
Mailing Address - Street 1:229 SEBASTIAN BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958
Mailing Address - Country:US
Mailing Address - Phone:772-581-0016
Mailing Address - Fax:772-581-1198
Practice Address - Street 1:229 SEBASTIAN BOULEVARD
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958
Practice Address - Country:US
Practice Address - Phone:772-581-0016
Practice Address - Fax:772-581-1198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME78368207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0095910OtherWELLMED
FL35392OtherBLUE CROSS BLUE SHIELD OF FLORIDA
FLDB1340OtherRAILROAD MEDICARE
FLK5228Medicare PIN
FLDB1340OtherRAILROAD MEDICARE