Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 12007207 | IN |
NPI | 1255308011 |
---|---|
Provider Name | Dr. Lawrence I Goldblatt |
First Address | Indianapolis, IN 46202-5211 |
Second Address | Indianapolis, IN 46202-5211 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000211690 | ANTHEM (01) | |
U32491 | (02) |