Provider Demographics
NPI:1093718272
Name:BLAZER, DAVID J (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:BLAZER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:127 CRESTVIEW PARK DR
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-2855
Mailing Address - Country:US
Mailing Address - Phone:615-446-5121
Mailing Address - Fax:615-446-1357
Practice Address - Street 1:113 HIGHWAY 70 E
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2080
Practice Address - Country:US
Practice Address - Phone:615-441-4450
Practice Address - Fax:615-446-1357
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD26023207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3086151Medicaid
TN3158418OtherBLUE CROSS BLUE SHIELD TN
060061304OtherRAILROAD MEDICARE PIN
060061304OtherRAILROAD MEDICARE PIN
TN3086151Medicaid