Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 3561 | OH |
NPI | 1922032556 |
---|---|
Provider Name | Dr. Johnthan D Block |
First Address | Wooster, OH 44691-7114 |
Second Address | Wooster, OH 44691-7114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000377701 | ANTHEM (01) | OH |
251924207-00 | BWC (01) | OH |
2601643 | (05) | OH |
U81934 | (02) | OH |