Provider Demographics
NPI:1316022627
Name:BLOMERT, DAVID M (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:BLOMERT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:601 S. ENOTA DRIVE
Mailing Address - Street 2:STE. Q
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501
Mailing Address - Country:US
Mailing Address - Phone:770-533-8406
Mailing Address - Fax:770-533-8409
Practice Address - Street 1:1292 ATHENS ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30507-7000
Practice Address - Country:US
Practice Address - Phone:770-531-5654
Practice Address - Fax:770-532-5341
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2010-02-19
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Provider Licenses
StateLicense IDTaxonomies
GA040870207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00679698CMedicaid
GA08BBWBZMedicare PIN
GAG15966Medicare UPIN