Doctor Name: | ALEX BLAZE |
NPI Number: | 1316394489 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | MA60630103 |
Business Practice Address: | 2311 S Kent Des Moines Rd Apt A103 Des Moines, WA - 981987083 |
Business Phone Number: | 8082381783 |
Business Fax Number: | |
Mailing Address: | 2311 S Kent Des Moines Rd Apt A103, DES MOINES |
State: | WA |
Postal Code: | 981987083 |
Phone Number: | 8082381783 |
Fax Number: | |
NPI Enumeration Date: | 05/19/2016 |
NPI Last Update Date: | 05/19/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | MA60630103 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |