Provider Demographics
NPI:1518904473
Name:BLAZIER, DWIGHT STEPHEN (CRNA)
Entity Type:Individual
Prefix:MR
First Name:DWIGHT
Middle Name:STEPHEN
Last Name:BLAZIER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 RIVERVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-6020
Mailing Address - Country:US
Mailing Address - Phone:256-766-3031
Mailing Address - Fax:
Practice Address - Street 1:440 RIVERVIEW CIR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-6020
Practice Address - Country:US
Practice Address - Phone:256-766-3031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-046613367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000051555Medicare ID - Type Unspecified
ALR35826Medicare UPIN