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Contact Information

BENJAMIN D BLOSSOM, MD
499 GLOSTER CREEK VLG
SUITE A-2
TUPELO, MS38801-4600
 Phone: 662-620-6992
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Cardiovascular Disease

207RC0000X 11 Physician/Internal Medicine
Indicates primary specialty

NPI Profile & details for BENJAMIN D BLOSSOM · (Male)

NPI # 1477648087
Status Active
Credentials MD
Entity Individual
Enumeration date 10/03/2006
Last updated 06/28/2011 - About 15 years ago
Sole proprietor 1 No
Identifiers
  • MS License # 19111
  • MS Medicaid 03670007
Hospital affiliation(s)
  • NORTH MISSISSIPPI MEDICAL CENTER - (Acute Care)
    830 S GLOSTER
    TUPELO, MS 38801
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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