MEDICARE: DR. MAURICE WILLIAM BLODGETT D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	2001013136	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386683712
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAURICE WILLIAM BLODGETT D.O.

Provider Business Mailing Address
First Line	:	3200 GRAND AVENUE
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50312
Country	:	US
Telephone Number	:	515-271-1616
Fax Number	:

Provider Business Practice Location Address
First Line	:	8350 N CHURCH RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64158-1104
Country	:	US
Telephone Number	:	877-337-7472
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	01/13/2022

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