Provider Demographics
NPI:1003899618
Name:BLASKOWSKI, PAUL LEO (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:LEO
Last Name:BLASKOWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:USA HC, BLD 682
Mailing Address - Street 2:FAMILY PRACTICE
Mailing Address - City:SCHOFIELD BARRACKS
Mailing Address - State:HI
Mailing Address - Zip Code:96857-5460
Mailing Address - Country:US
Mailing Address - Phone:808-433-8155
Mailing Address - Fax:
Practice Address - Street 1:USA HC, BLD 682
Practice Address - Street 2:FAMILY PRACTICE
Practice Address - City:SCHOFIELD BARRACKS
Practice Address - State:HI
Practice Address - Zip Code:96857-5460
Practice Address - Country:US
Practice Address - Phone:808-433-8155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI40887020207Q00000X
HI15437207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine