Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 30198 | AZ |
NPI | 1114982394 |
---|---|
Provider Name | Richard Blumrick |
First Address | Los Angeles, CA 90074-6765 |
Second Address | Chandler, AZ 85224-5295 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2006 |
Last Update Date | 29/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
690471 | (05) | AZ |