Provider Demographics
NPI:1164663431
Name:BLOCH, ALAN BRUCE (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:BRUCE
Last Name:BLOCH
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 1:1639 COLEBROOK CIRCLE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-1424
Mailing Address - Country:US
Mailing Address - Phone:404-634-5158
Mailing Address - Fax:
Practice Address - Street 1:1639 COLEBROOK CIRCLE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-1424
Practice Address - Country:US
Practice Address - Phone:404-634-5158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0318772083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine