Provider Demographics
NPI:1053411579
Name:BLATT, DAVID R (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:BLATT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 ROCKY MOUNTAIN AVE STE 340
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9004
Mailing Address - Country:US
Mailing Address - Phone:704-957-4219
Mailing Address - Fax:970-203-7179
Practice Address - Street 1:2500 ROCKY MOUNTAIN AVE STE 340
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-9004
Practice Address - Country:US
Practice Address - Phone:704-957-4219
Practice Address - Fax:970-203-7179
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35076198207T00000X
CO47844207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2115222Medicaid
CO59427256Medicaid
CO020299OtherKAISER COMMERCIAL NUMBER
CO59427256Medicaid
OHBL0876546Medicare ID - Type Unspecified
OH2115222Medicaid