Provider Demographics
NPI:1003842162
Name:BLAZAR, BRUCE ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ROBERT
Last Name:BLAZAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:420 DELAWARE STREET SE
Mailing Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS, MMC 109
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-626-2961
Mailing Address - Fax:612-626-4074
Practice Address - Street 1:516 DELAWARE STREET SE
Practice Address - Street 2:UNIVERSITY OF MN PHYSICIANS, PWB FIFTH FLOOR, CLINIC 5B
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-273-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN25330208000000X, 2080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1008985OtherPREFERRED ONE
KS2086719301Medicaid
WI30695100Medicaid
MN761878600Medicaid
SD7777470Medicaid
LA1986259Medicaid
MN132947OtherUCARE
OH0243838Medicaid
ND10387Medicaid
MN768027OtherARAZ
MT0052326Medicaid
MN12-24756OtherMEDICA CHOICE
MN12-70281OtherMEDICA PRIMARY
MNHP21976OtherHEALTHPARTNERS
SD7777470Medicaid
MT0052326Medicaid
OH0243838Medicaid