Provider Demographics
NPI:1275580268
Name:BLASCHKE, JON WORD (MD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:WORD
Last Name:BLASCHKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:608 NW 9TH ST
Mailing Address - Street 2:SUITE 4204
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-1049
Mailing Address - Country:US
Mailing Address - Phone:405-232-3095
Mailing Address - Fax:405-232-3094
Practice Address - Street 1:608 NW 9TH ST
Practice Address - Street 2:SUITE 4204
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-1049
Practice Address - Country:US
Practice Address - Phone:405-232-3095
Practice Address - Fax:405-232-3094
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK11711207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK$$$$$$$$$PMedicare PIN
D34414Medicare UPIN