Provider Demographics
NPI:1194858225
Name:BLASS, BARRY C (DPM)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:C
Last Name:BLASS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 W HILLSBOROUGH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-1312
Mailing Address - Country:US
Mailing Address - Phone:813-238-3631
Mailing Address - Fax:813-882-0291
Practice Address - Street 1:1020 W HILLSBOROUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-1312
Practice Address - Country:US
Practice Address - Phone:813-238-3631
Practice Address - Fax:813-882-0291
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO0000694213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0059744OtherGHI
FLT84637Medicare UPIN
FL87305XMedicare PIN
FL87305AMedicare PIN
FL0059744OtherGHI
FL87305YMedicare PIN
FL87305Medicare PIN