Individual
MR. PHILLIP WAYNE BLAICH
Active
Individual
MR. PHILLIP WAYNE BLAICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
085003348
IL
363AM0700X
Medical Physician Assistant
Primary
PA9103668
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
020471300
—
FL
Enumeration date
04/24/2006
Last updated
12/10/2021
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