Blotter, James Wallentine

Blotter, James Wallentine is an individual health care provider with primary practice located at 2245 N 400 E Ste 301, North Logan UT 84341-1892. He recently has only one registered license in Allopathic & Osteopathic Physicians / Plastic Surgery within the Head & Neck, which is considered as his primary health care specialty. Blotter, James Wallentine can be contacted via phone (435) 753-7880.

Contact Information

Primary practice address
2245 N 400 E Ste 301 North Logan UT 84341-1892
Phone: (435) 753-7880
Fax: (435) 753-5845
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Plastic Surgery within the Head & Neck 207YX0007X 3082587-1205 Utah

Profile Details

NPI number 1962499673
LBN Legal business name Blotter, James Wallentine
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 29th, 2005
Last updated Mar 7th, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1962499673 NPPES
Idaho Other M-8784 IDAHO STATE LICENSE
Idaho MEDICAID 87037196400 IDAHO STATE LICENSE

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