Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1649425299 |
---|---|
Provider Name | Mr. James Arthur Blane IV |
First Address | Indianapolis, IN 46202-2803 |
Second Address | Indianapolis, IN 46202-2803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/11/2008 |
Last Update Date | 24/11/2008 |