Provider Demographics
NPI:1346408127
Name:BLISSARD, PAUL KING (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:KING
Last Name:BLISSARD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4310 JAMES CASEY ST
Mailing Address - Street 2:1-C
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-1251
Mailing Address - Country:US
Mailing Address - Phone:512-443-2228
Mailing Address - Fax:512-443-2227
Practice Address - Street 1:4310 JAMES CASEY ST
Practice Address - Street 2:1-C
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1251
Practice Address - Country:US
Practice Address - Phone:512-443-2228
Practice Address - Fax:512-443-2227
Is Sole Proprietor?:No
Enumeration Date:2008-05-28
Last Update Date:2012-01-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXF6453207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX084120701OtherMEDICAID GROUP ID
TX00N25XOtherMEDICARE
TXF6453OtherTEXAS MEDICAL LICENSE
TX137945507Medicaid
TX137945510OtherTEXAS HEALTH STEPS ID
TX137945507Medicaid