Blazer, Douglas Alan
Blazer, Douglas Alan is an individual health care provider with primary practice located at 3475 S Alpine Rd , Rockford IL 61109-2604. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as his primary health care specialty. Blazer, Douglas Alan can be contacted via phone (815) 874-8000.Contact Information
Primary practice address
3475 S Alpine Rd
Rockford IL 61109-2604
Phone: (815) 874-8000
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | 085004130 | Illinois |
Profile Details
| NPI number | 1104101823 |
|---|---|
| LBN Legal business name | Blazer, Douglas Alan |
| Credentials | Physician Assistant (PA) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 13th, 2011 |
| Last updated | Oct 13th, 2011 - about 13 years ago |
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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1104101823 | NPPES |
| Illinois | Other | 085004130 | STATE MEDICAL LICENSE |
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