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NPI Code Detail

MEDICARE: DR. ROGER M BLAUVELT MD

MEDICARE: DR. ROGER M BLAUVELT MD
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
1174400000XSpecialistMD00034945WA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3GAB38443OTHERWAMEDICARE LEGACY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15677BLOTHERWAREGENCE
2172908OTHERWALABOR & INDUSTRIES
41101260OTHERWADSHS
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1932187341
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROGER M BLAUVELT MD
Provider Business Mailing Address
First Line : 122 3RD ST NE
Second Line :
City : AUBURN
State : WA
Zip : 98002-4013
Country : US
Telephone Number : 253-833-7750
Fax Number : 253-887-9804
Provider Business Practice Location Address
First Line : 122 3RD ST NE
Second Line :
City : AUBURN
State : WA
Zip : 98002-4013
Country : US
Telephone Number : 253-833-7750
Fax Number : 253-833-7469
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2006
Last Update Date : 02/14/2020

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