Jacob Clarence Blazo
Internal Medicine in Saint Joseph, MI. Individual provider (NPI-1).
NPI number1861716748
StatusActive
Last updated in NPPESMay 19, 2015
Details
- NPI
- 1861716748
- Entity type
- Individual (NPI-1)
- Name
- Jacob Clarence Blazo
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Mar 21, 2010
- Last updated
- May 19, 2015
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207R00000X | Internal Medicine | 5101020805 | MI | Yes |
Practice location
1234 Napier AveSaint Joseph, MI 49085-2112
Phone 269-985-4632 · Fax 269-985-4623
Mailing address
1234 Napier AveSaint Joseph, MI 49085-2112
Phone 269-985-4632 · Fax 269-985-4535
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