Provider Demographics
NPI:1942488531
Name:BLIZNAK, JOHN HOUSTON (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HOUSTON
Last Name:BLIZNAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2898
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79604-2898
Mailing Address - Country:US
Mailing Address - Phone:325-677-2201
Mailing Address - Fax:325-677-7641
Practice Address - Street 1:401 CYPRESS
Practice Address - Street 2:#110
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-5122
Practice Address - Country:US
Practice Address - Phone:325-677-2201
Practice Address - Fax:325-677-7641
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.0265272085R0202X
TXN06522085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CA084OtherBLUE CROSS BLUE SHIELD OF TEXAS
TX203444901Medicaid
8L13254Medicare PIN