Individual
CHRISTOPHER SHANE BLOMBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, MS
Contact information
Practice address
859 WINTER ST, LUCEDALE, MS 39452-6603
(601) 947-3161
(601) 947-1331
Mailing address
4864 JACKSON ST, FAMILY MEDICINE, MONROE, LA 71202-6400
(318) 330-7650
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
25078
MS
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/15/2014
Last updated
07/21/2022
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