Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 5968 | AL |
N | 1223P0300X | Periodontist | 61911 | CA |
NPI | 1013267954 |
---|---|
Provider Name | Dr. Eric M. Blasingame |
First Address | Birmingham, AL 35233-2005 |
Second Address | Birmingham, AL 35233-2005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2012 |
Last Update Date | 09/07/2014 |