Individual
BLAIR DAY WOOTEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
10122 E 10TH ST STE 100, INDIANAPOLIS, IN 46229-2697
(317) 355-5717
(614) 566-6902
Mailing address
10122 E 10TH ST STE 100, INDIANAPOLIS, IN 46229-2697
(317) 355-5717
(317) 355-3760
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
11023402A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300090716
—
IN
Enumeration date
04/27/2021
Last updated
05/31/2024
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