Provider Demographics
NPI:1437196334
Name:BLAHOUS, EDWARD G JR (DPM)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:G
Last Name:BLAHOUS
Suffix:JR
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 1:1551 NW 54TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-3845
Mailing Address - Country:US
Mailing Address - Phone:206-782-3383
Mailing Address - Fax:206-782-9585
Practice Address - Street 1:1551 NW 54TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3845
Practice Address - Country:US
Practice Address - Phone:206-782-3383
Practice Address - Fax:206-782-9585
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000573213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8205312Medicaid
WAU62441Medicare UPIN
WA8205312Medicaid