Individual
DR. BENJAMIN DAVID BLOSSOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
499 GLOSTER CREEK VLG, SUITE A-2, TUPELO, MS 38801-4600
(662) 620-6992
Mailing address
499 GLOSTER CREEK VLG STE A2, CARDIOLOGY ASSOCIATES OF NORTH MS, TUPELO, MS 38801-4749
(662) 620-6992
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
19111
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03670007
—
MS
Enumeration date
10/03/2006
Last updated
06/28/2011
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