Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 34003712 | OH |
NPI | 1497759369 |
---|---|
Provider Name | Dr. Glenn D Blankenhorn III |
First Address | Massillon, OH 44646-3613 |
Second Address | Massillon, OH 44646-3613 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2005 |
Last Update Date | 17/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0586852 | (05) | OH |
A15829 | (02) | OH |