Provider Demographics
NPI:1720590268
Name:BREZINA, BLAIRE FRITCHIE (MPAS, PA-C)
Entity Type:Individual
Prefix:
First Name:BLAIRE
Middle Name:FRITCHIE
Last Name:BREZINA
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:BLAIRE
Other - Last Name:FRITCHIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPAS, PA-C
Mailing Address - Street 1:18200 KATY FWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77094-1285
Mailing Address - Country:US
Mailing Address - Phone:832-227-1000
Mailing Address - Fax:
Practice Address - Street 1:18200 KATY FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77094-1285
Practice Address - Country:US
Practice Address - Phone:832-227-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-24
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
TXPA11560363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant