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 15 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 |
Popular Providers
-
Morris, Matthew W
1340 Charles St Ste 100 , Rockford IL 61104-2200 -
Kucia, Tammy M
2300 N Rockton Ave , Rockford IL 61103-3619 -
Ferris, Kathryn E
3505 N Bell School Rd , Rockford IL 61114-6624 -
Langguth, Erin Ashleigh
1200 W State St , Rockford IL 61102-2112 -
Masterson, Andrew J
698 Featherstone Rd , Rockford IL 61107-6303 -
Hartzell, Melissa Shea
1200 W State St , Rockford IL 61102-2112 -
Whitney, Alexander
1055 Featherstone Rd Ste C , Rockford IL 61107-5904 -
Agumadu, Vivian C
2400 N Rockton Ave , Rockford IL 61103-3655