| NPI | 1619954906 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE GARY BLANK President 740-633-4188 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: OH 36002569B) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: WV 00239) |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2008-04-20 |