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Individual

DR. JOHN TRAVIS BLAZE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PH.D.

Contact information

Practice address
5396 LONGHORN TRL, GULF BREEZE, FL 32563-9353
(850) 270-7773
Mailing address
5396 LONGHORN TRL, GULF BREEZE, FL 32563-9353
(850) 270-7773

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PY9366
FL

Other

Enumeration date
03/22/2013
Last updated
08/18/2023
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