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Individual
BRUCE GARY BLANK
Active
Individual
BRUCE GARY BLANK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
00239
WV
213E00000X
Podiatrist
Primary
36002569
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000141557
ANTHEM BCBC
OH
05
—
0099535000
—
WV
05
—
01548623
—
PA
05
—
0747213
—
OH
01
—
2102991
MAMSI
—
01
—
2569
HEALTH PLAN
OH
01
—
4295099
AETNA
—
01
—
480027937
RAILROAD MEDICARE
—
01
—
6491296002
CIGNA
—
Enumeration date
02/06/2006
Last updated
03/19/2014
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