Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | LO.10 | OH |
Y | 222Z00000X | Podiatrist | LO.10 | OH |
NPI | 1023331014 |
---|---|
Provider Name | Mr. Craig A Blue |
First Address | Marion, OH 43302-6416 |
Second Address | Marion, OH 43302-6416 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2010 |
Last Update Date | 02/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2281534 | (05) | OH |