Healthcare Provider Details

I. General information

NPI: 1083119945
Provider Name (Legal Business Name): SARAH BLAZOVIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2018
Last Update Date: 04/03/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 S 31ST ST
TEMPLE TX
76508-0001
US

IV. Provider business mailing address

751 E 36TH AVE STE 100
ANCHORAGE AK
99503-4166
US

V. Phone/Fax

Practice location:
  • Phone: 254-935-5063
  • Fax:
Mailing address:
  • Phone: 907-222-5090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number178930
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: