Provider Demographics
NPI:1356411599
Name:BLOCKER, EDWARD RILEY (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:RILEY
Last Name:BLOCKER
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 1:16 WRIGHTS POINT CIR
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-6955
Mailing Address - Country:US
Mailing Address - Phone:843-522-7100
Mailing Address - Fax:843-322-3234
Practice Address - Street 1:300 MIDTOWN DR
Practice Address - Street 2:SUITE 20
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29906-5200
Practice Address - Country:US
Practice Address - Phone:843-522-7100
Practice Address - Fax:843-322-3234
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17331207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG662416305OtherMEDICARE PTAN
SC173314Medicaid
SCG662416305OtherMEDICARE PTAN