Provider Demographics
NPI:1053465633
Name:BLAZES, WILLIAM JAY (DO)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JAY
Last Name:BLAZES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:PO BOX 211
Mailing Address - Street 2:
Mailing Address - City:SPARTANSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16434-0211
Mailing Address - Country:US
Mailing Address - Phone:814-654-7334
Mailing Address - Fax:814-654-7553
Practice Address - Street 1:132 MECHANIC ST
Practice Address - Street 2:
Practice Address - City:SPARTANSBURG
Practice Address - State:PA
Practice Address - Zip Code:16434-1026
Practice Address - Country:US
Practice Address - Phone:814-654-7334
Practice Address - Fax:814-654-7553
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS0139982207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0S013982OtherSTATE LICENSE