Healthcare Provider Details

I. General information

NPI: 1285991703
Provider Name (Legal Business Name): CATHERINE JEAN BLASSER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATHERINE JEAN HENDERSHOT D.O.

II. Dates (important events)

Enumeration Date: 04/22/2012
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1381 S PATRICK DR
PATRICK AIR FORCE BASE FL
32925-3606
US

IV. Provider business mailing address

1381 S PATRICK DR
PATRICK AFB FL
32925-3606
US

V. Phone/Fax

Practice location:
  • Phone: 321-494-8241
  • Fax:
Mailing address:
  • Phone: 321-494-8241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS21383
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number34.013196
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34.013196
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberOS21383
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number34.013196
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: