Provider Demographics
NPI:1497034888
Name:BLAAUW, JEFFREY JAMES (ATP)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:JAMES
Last Name:BLAAUW
Suffix:
Gender:M
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2019 SUMMERHILL RD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501-3580
Mailing Address - Country:US
Mailing Address - Phone:903-223-9001
Mailing Address - Fax:903-794-8666
Practice Address - Street 1:2019 SUMMERHILL RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501
Practice Address - Country:US
Practice Address - Phone:903-223-9001
Practice Address - Fax:903-794-8666
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXATP13882247200000X
TX332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment