Individual
DR. EDDYE BLOSSOM II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4864 JACKSON ST, MONROE, LA 71202-6400
(318) 330-7626
(318) 330-7648
Mailing address
4864 JACKSON ST, MONROE, LA 71202-6400
(318) 330-7626
(318) 330-7648
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
45438
TN
207V00000X
Obstetrics & Gynecology Physician
E-6247
AR
207V00000X
Obstetrics & Gynecology Physician
Primary
MD.204270
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2138014
—
LA
Enumeration date
05/04/2007
Last updated
01/24/2013
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