Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | ||
Y | 103T00000X | Psychologist |
NPI | 1013251701 |
---|---|
Provider Name | Dr. Andrew H Bloch |
First Address | Mountain Home, TN 37684 |
Second Address | Mountain Home, TN 37684 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2012 |
Last Update Date | 19/11/2012 |