Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | SC | |
N | 222Z00000X | Podiatrist | SC | |
N | 224P00000X | Prosthetist | SC |
NPI | 1104997907 |
---|---|
Provider Name | Mr. Paul David Blakeley |
First Address | Spartanburg, SC 29307-1343 |
Second Address | Spartanburg, SC 29307-1343 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7701424 | (05) | NC |
DME285 | (05) | SC |