Individual
JONATHAN JAMES BLAZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1250 W NATIONAL RD STE 400, ENGLEWOOD, OH 45315
(937) 832-3300
Mailing address
1250 W NATIONAL RD STE 400, ENGLEWOOD, OH 45315-9506
(937) 836-6000
(937) 832-4805
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
66669-20
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0310911
—
OH
Enumeration date
04/06/2015
Last updated
11/20/2020
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