Provider Demographics
NPI:1629266770
Name:BLATNIK, JEFFREY ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ALAN
Last Name:BLATNIK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-454-8877
Mailing Address - Fax:877-991-4780
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:DIV SURG MIS, STE 12B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-454-8877
Practice Address - Fax:877-991-4780
Is Sole Proprietor?:No
Enumeration Date:2007-10-12
Last Update Date:2024-04-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2015014712208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200026246Medicaid
MO1629266770Medicaid