Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 13236 | MO |
N | 1223E0200X | Endodontist | 6100 | KS |
NPI | 1164494332 |
---|---|
Provider Name | Dr. Robert Eugene Blundell JR. |
First Address | Shawnee, KS 66217-9437 |
Second Address | Kansas City, MO 64108-2716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2006 |
Last Update Date | 08/02/2013 |