Provider Demographics
NPI:1770630535
Name:BLITZ-SEIBERT, ALISA J (MD)
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:J
Last Name:BLITZ-SEIBERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1100 WHEATON WAY
Mailing Address - Street 2:SUITE F&G
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-4459
Mailing Address - Country:US
Mailing Address - Phone:360-621-2696
Mailing Address - Fax:844-602-4646
Practice Address - Street 1:8042 NW WILDCAT LAKE RD
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-9571
Practice Address - Country:US
Practice Address - Phone:360-204-4054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00045992207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8464430Medicaid