Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 2003002797 | MO |
NPI | 1003953407 |
---|---|
Provider Name | Dr. Dawn E Zablocki |
First Address | Springfield, MO 65801-2580 |
Second Address | Springfield, MO 65804-2203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2007 |
Last Update Date | 15/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
150496001 | (05) | AR |
175118 | MO BLUE SHIELD (01) | MO |
208764605 | (05) | MO |
82524 | ARK BLUE SHIELD (01) | AR |
D69238 | (02) |