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Organization
PAUL BLISSARD
Active
Organization
PAUL BLISSARD
Active
Other names
PAUL K BLISSARD MD FAMILY MEDICINE
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL KING BLISSARD M.D. (MEDICAL DIRECTOR)
(512) 443-2228
Entity
Organization
Contact information
Practice address
4310 JAMES CASEY ST, STE1-C, AUSTIN, TX 78745-1251
(512) 443-2228
(512) 443-2227
Mailing address
4310 JAMES CASEY ST, STE 1-C, AUSTIN, TX 78745-1251
(512) 443-2228
(512) 443-2227
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
F6453
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00N25X
BLUE CROSS NO.
TX
01
—
084120701
TPI NUMBER
TX
05
—
137945507
—
TX
01
—
137945510
EPSDT RENDERING NO.
TX
01
—
86W800
BLUE CROSS RENDERING NO.
TX
Enumeration date
04/11/2007
Last updated
01/03/2012
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