Individual
JACOB I. BLAZZARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1433 5TH ST, CLARKSTON, WA 99403-2714
(509) 758-5141
(509) 758-5299
Mailing address
901 RACHEL ST, TROY, ID 83871-6002
(208) 310-2777
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA-1221
ID
363A00000X
Physician Assistant
Primary
PA60099484
WA
363AM0700X
Medical Physician Assistant
361
WY
363AM0700X
Medical Physician Assistant
PA60099484
WA
Other
Enumeration date
11/01/2006
Last updated
04/01/2024
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