Individual
GREG BLOXDORF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
29000 CENTER RIDGE RD, WESTLAKE, OH 44145-5293
(440) 835-8000
Mailing address
9160 AVERY RD, BROADVIEW HEIGHTS, OH 44147-2510
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
34005565B
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0903642
—
OH
01
—
942460636334
CARESOURCE
OH
Enumeration date
05/27/2006
Last updated
07/08/2007
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