Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 35027415 | OH |
NPI | 1134167950 |
---|---|
Provider Name | Dr. Harley Myron Blank |
First Address | Columbus, OH 43213-1546 |
Second Address | Columbus, OH 43205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2006 |
Last Update Date | 17/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0167939 | (05) | OH |
C00913 | (02) | OH |