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General NPI Number Information
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NPI Number | 1235417817
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Entity Type | Individual
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Provider Name | JEFFREY S BLASICK D.O.
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Gender | Male
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Dates
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Enumeration Date | 07/29/2011
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Last Update Date | 08/20/2024
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Provider Practice Location Address
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Address Line | 7005 WOODWAY DR STE 101
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City | WOODWAY
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State | TX
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Zip | 76712-6160
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Country | US
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Telephone | 254-224-8062
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Fax | 254-224-6385
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Provider Business Mailing Address
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Address Line | PO BOX 16190
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City | BELFAST
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State | ME
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Zip | 04915-4056
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Country | US
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Telephone | 254-754-0375
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Fax | 254-754-2667
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | Q6735
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License Number State | TX
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