Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 0116015702 | VA |
Y | 208600000X | Surgeon | 0116015702 | VA |
NPI | 1003073602 |
---|---|
Provider Name | Mr. Patrick Tyson Blatchford |
First Address | Arkansas City, KS 67005-2200 |
Second Address | Arkansas City, KS 67005-2200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2008 |
Last Update Date | 31/01/2022 |