Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | OI00000319 | WA |
N | 222Z00000X | Podiatrist | OI00000319 | WA |
Y | 224P00000X | Prosthetist | PS00000319 | WA |
NPI | 1245422633 |
---|---|
Provider Name | Ryan V Blanck |
First Address | Seattle, WA 98122-5395 |
Second Address | Seattle, WA 98122-5395 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2007 |
Last Update Date | 09/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9036963 | (05) | WA |