Healthcare Provider Details

I. General information

NPI: 1134128184
Provider Name (Legal Business Name): R DENNIS BLOSE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 01/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 MOUNT CARMEL MALL SUITE 100
COLUMBUS OH
43222-1553
US

IV. Provider business mailing address

750 MOUNT CARMEL MALL SUITE 100
COLUMBUS OH
43222-1553
US

V. Phone/Fax

Practice location:
  • Phone: 614-434-2400
  • Fax: 614-434-2499
Mailing address:
  • Phone: 614-434-2400
  • Fax: 614-434-2499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35030950
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: