1861458424

Everything you always wanted to know about MR. BLAICH WAYNE PHILLIP PA-C but were afraid to ask.

MR. BLAICH WAYNE PHILLIP PA-C

You can also download the this 1861458424 data report as csv | excel | json | xml
Provider Prefix Provider Last Name Provider Middle Name Provider First Name Provider Credential
MR. BLAICH WAYNE PHILLIP PA-C
Gender:
Male
Enumeration date:
2006-04-24
Last update date:
2018-01-17
Current as of:
Is sole proprietor?:
No
Is organization subpart?:
No
In PECOS?:
Yes
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Identifiers

identifier description issuer state

Taxonomies

Taxonomy State License Number Primary?
363AM0700X Medical IL 085003348 Y

Phone Numbers

Type Number
Mailing Address Telephone Number 8507703220
Practice Location Address Telephone Number 8507703220
Practice Location Address Fax Number 8507703225

Addresses

Type Address City State Postal Country
Mailing Address 2420 JENKS AVE PANAMA CITY FL 32405 FL
Practice Location Address 2420 JENKS AVE UNIT 5 PANAMA CITY FL 0 FL

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NPI Name Address State City
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1912951922 GILMORE, LAURA
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1962456723 STICKLER, MICHAEL
Individual
2420 JENKS AVE FL PANAMA CITY