Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 39602 | CA |
NPI | 1750363602 |
---|---|
Provider Name | Dr. Brian Burke Blatter |
First Address | Concord, CA 94520-2011 |
Second Address | Concord, CA 94520-2011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2005 |
Last Update Date | 08/07/2007 |