Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 35-054271 | OH |
Y | 111NI0900X | Internist | 35-054271 | OH |
N | 207RA0401X | Internist - Addiction Medicine | 35054271T | OH |
NPI | 1891756540 |
---|---|
Provider Name | Blayre R Tuggle |
First Address | North Olmsted, OH 44070-0789 |
Second Address | Columbus, OH 43213-2425 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2006 |
Last Update Date | 13/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D97856 | (02) |