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General NPI Number Information
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NPI Number | 1790757490
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Entity Type | Individual
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Provider Name | BRUCE GARY BLANK DPM
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Gender | Male
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Dates
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Enumeration Date | 02/06/2006
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Last Update Date | 03/19/2014
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Provider Practice Location Address
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Address Line | 92 N 4TH ST SUITE 27
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City | MARTINS FERRY
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State | OH
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Zip | 43935-1691
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Country | US
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Telephone | 740-633-4188
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Fax | 740-633-4716
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Provider Business Mailing Address
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Address Line | 92 N 4TH ST SUITE 27
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City | MARTINS FERRY
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State | OH
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Zip | 43935-1691
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Country | US
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Telephone | 740-633-4188
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Fax | 740-633-4716
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 36002569
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 00239
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License Number State | WV
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