Provider Demographics
NPI:1699065128
Name:LINDBLOOM, BENJAMIN J (MD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:J
Last Name:LINDBLOOM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 HOSPITAL DR STE 110
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-2453
Mailing Address - Country:US
Mailing Address - Phone:386-586-1910
Mailing Address - Fax:386-586-1912
Practice Address - Street 1:21 HOSPITAL DR STE 110
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-2453
Practice Address - Country:US
Practice Address - Phone:386-586-1910
Practice Address - Fax:386-586-1912
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME132052207X00000X
MA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020771900Medicaid
FLXJZ3JOtherBCBS
FLJA322ZOtherMEDICARE