Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 28485 | WI |
NPI | 1073755468 |
---|---|
Provider Name | Dr. Lon Allen Blaser |
First Address | Eau Claire, WI 54701-5912 |
Second Address | Eau Claire, WI 54701-5912 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2009 |
Last Update Date | 11/12/2012 |