Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 0015910 | GA |
N | 208600000X | Surgeon | 0015910 | GA |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 015910 | GA |
NPI | 1124071204 |
---|---|
Provider Name | Dr. James Saloman Blanc |
First Address | Atlanta, GA 30328-4221 |
Second Address | Atlanta, GA 30328-4221 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 20/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000063236A | (05) | GA |
D39428 | (02) | GA |