Provider Demographics
NPI:1912201450
Name:PIFER, BLAKE (BA IN ZOOLOGY)
Entity Type:Individual
Prefix:
First Name:BLAKE
Middle Name:
Last Name:PIFER
Suffix:
Gender:M
Credentials:BA IN ZOOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 WINNER AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43203-1956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:91 WINNER AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43203-1956
Practice Address - Country:US
Practice Address - Phone:419-233-1479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-24
Last Update Date:2010-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program