Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | R7908 | MO |
N | 207VG0400X | Gynecologist | R7908 | MO |
N | 207VX0000X | Obstetrician | R7908 | MO |
NPI | 1407880081 |
---|---|
Provider Name | Robert J Blaskiewicz |
First Address | Saint Louis, MO 63117-1811 |
Second Address | Saint Louis, MO 63117-1818 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 28/12/2009 |