Healthcare Provider Details

I. General information

NPI: 1396713095
Provider Name (Legal Business Name): MAURY NELSON BLITMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 N VERCLER RD
SPOKANE VALLEY WA
99216-1020
US

IV. Provider business mailing address

1204 N VERCLER RD STE 101
SPOKANE VALLEY WA
99216-1020
US

V. Phone/Fax

Practice location:
  • Phone: 509-228-1000
  • Fax: 509-252-9300
Mailing address:
  • Phone: 509-228-1000
  • Fax: 509-252-9300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD00048643
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2003-0406
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD169632
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number2003-0406
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: