Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 11757 | AZ |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 11757 | AZ |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 11757 | AZ |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 11757 | AZ |
NPI | 1073576856 |
---|---|
Provider Name | Dr. Richard Mark Blew |
First Address | Tucson, AZ 85710-2119 |
Second Address | Tucson, AZ 85710-2156 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2006 |
Last Update Date | 11/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
224551-01 | (05) | AZ |
E39504 | (02) |