Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 35076198 | OH |
Y | 207T00000X | Neurosurgeon | 47844 | CO |
NPI | 1053411579 |
---|---|
Provider Name | Dr. David R. Blatt |
First Address | Loveland, CO 80538-9004 |
Second Address | Loveland, CO 80538-9004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2006 |
Last Update Date | 22/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
020299 | KAISER COMMERCIAL NUMBER (01) | CO |
2115222 | (05) | OH |
59427256 | (05) | CO |
G03012 | (02) | OH |