Individual
DR. MARC BENJAMIN BLATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
8773 PERIMETER PARK CT, JACKSONVILLE, FL 32216-1165
(904) 493-3390
(904) 493-3395
Mailing address
8773 PERIMETER PARK CT, JACKSONVILLE, FL 32216-1165
(904) 493-3390
(904) 493-3395
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
OS7862
FL
208M00000X
Hospitalist Physician
Primary
OS7862
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03058
FLORIDA BLUE
FL
01
—
03058Z
MEDICARE - INDIVIDUAL
FL
01
—
110220691
RR MEDICARE
FL
01
—
195802
WELLCARE
FL
01
—
2610299-00
MEDICAID - GROUP
FL
01
—
2615959-00
MEDICAID - INDIVIDUAL
FL
01
—
278741
AVMED
FL
01
—
45681
MEDICARE - GROUP
FL
Enumeration date
06/22/2005
Last updated
08/04/2016
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