Individual provider · Type 1 NPI

Douglas Alan Blazer, PA

Medical Physician Assistant · Rockford, IL

NPI number 1104101823 Active

Practice location

3475 S Alpine Rd
Rockford, IL 61109-2604

Specialties and licenses

TaxonomyCodeLicense
Medical Physician Assistant Primary 363AM0700X085004130 (IL)

Medical Physician Assistant: Definition to come...

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About NPI 1104101823

Douglas Alan Blazer, PA's National Provider Identifier is 1104101823, issued on Oct 13, 2011. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Rockford, IL. The record was last updated on Oct 13, 2011.