Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 25MD00121000 | NJ |
N | 222Z00000X | Podiatrist | 25MD00121000 | NJ |
Y | 213E00000X | Podiatrist | SC001495L | PA |
Y | 222Z00000X | Podiatrist | SC001495L | PA |
NPI | 1063479467 |
---|---|
Provider Name | Robert Paul Bloch |
First Address | Phila, PA 19144 |
Second Address | Phila, PA 19144 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2006 |
Last Update Date | 29/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
05406404 | (05) | PA |
T29495 | (02) |