Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 23635 | IA |
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 26752 | WI |
NPI | 1013907526 |
---|---|
Provider Name | Scott B Blanke |
First Address | La Crosse, WI 54601-8806 |
Second Address | La Crosse, WI 54601-8806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2005 |
Last Update Date | 10/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A02232 | (02) |