Organization
OCEAN ISLE BEACH FAMILY MEDICINE. PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL R. BLIZZARD DO (PHYSICIAN)
(910) 575-5004
Entity
Organization
Contact information
Practice address
120 CAUSEWAY DR STE 3, OCEAN ISLE BEACH, NC 28469-7581
(910) 575-5004
(855) 575-0700
Mailing address
120 CAUSEWAY DR STE 3, OCEAN ISLE BEACH, NC 28469-7581
(910) 575-5004
(855) 575-0700
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
181477
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1902162928
NPI
—
01
—
34D1040435
CLIA
—
05
—
5920193
—
NC
01
—
B502
MEDICARE PTAN
NC
Enumeration date
04/03/2012
Last updated
10/25/2017
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