Healthcare Provider Details

I. General information

NPI: 1437196334
Provider Name (Legal Business Name): EDWARD G BLAHOUS JR. D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 06/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 NW 54TH ST
SEATTLE WA
98107-3845
US

IV. Provider business mailing address

1551 NW 54TH ST
SEATTLE WA
98107-3845
US

V. Phone/Fax

Practice location:
  • Phone: 206-782-3383
  • Fax: 206-782-9585
Mailing address:
  • Phone: 206-782-3383
  • Fax: 206-782-9585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO00000573
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: