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Individual
RICHARD ALAN BLATTER
Active
Individual
RICHARD ALAN BLATTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
5101019997
MI
208800000X
Urology Physician
5315055574
MI
208800000X
Urology Physician
Primary
O-1041
ID
208800000X
Urology Physician
O-1041
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1154682565
—
MI
01
—
O-1041
IDAHO STATE LICENSE
ID
Enumeration date
06/01/2012
Last updated
07/21/2022
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