Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XS0106X | Orthopaedic Hand Surgeon | 49079 | AZ |
Y | 208200000X | Surgeon | 49079 | AZ |
Y | 208600000X | Surgeon | 49079 | AZ |
N | 208200000X | Surgeon | 4301092551 | MI |
N | 208600000X | Surgeon | 4301092551 | MI |
N | 208200000X | Surgeon | 49079 | AZ |
N | 208600000X | Surgeon | 49079 | AZ |
N | 2086S0122X | Plastic and Reconstructive Surgery | 49079 | AZ |
NPI | 1285896977 |
---|---|
Provider Name | Andrew Loren Blount |
First Address | Phoenix, AZ 85067-3269 |
Second Address | Phoenix, AZ 85013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2008 |
Last Update Date | 13/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PENDING | (05) | AZ |