Individual
GEORGE AMBROSE BLESTEL JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
12790
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
127909
—
SC
01
—
P00682386
RR MEDICARE
SC
Enumeration date
05/18/2006
Last updated
02/02/2018
Update your record
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