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Individual

DR. WAYNE S. BLOCKER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
407 N PARSONS AVE, STE 101, BRANDON, FL 33510-4537
(813) 681-9048
(813) 653-0088
Mailing address
407 N PARSONS AVE, STE 101, BRANDON, FL 33510-4537
(813) 681-9048
(813) 653-0088

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
ME 26545
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
01456
WELLCARE ID#
FL
05
0599810800
FL
01
09025
BCBS ID#
FL
01
09025Z
MEDICARE LEGACY NUMBER
FL
01
103483
AVMED ID#
FL
01
10D0861661
CLIA
FL
01
160002545
RAILROAD MEDICARE #
FL
01
4198947
AETNA PROVIDER #
FL
01
592413232
COMMERCIAL ID#
FL
Enumeration date
06/13/2005
Last updated
05/14/2008
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