Individual
KEVIN BLAZER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1928 ALCOA HWY STE 209, KNOXVILLE, TN 37920-1504
(865) 524-2547
(865) 219-5070
Mailing address
PO BOX 23329, NEW YORK, NY 10087-3329
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
PA955
TN
363A00000X
Physician Assistant
Primary
PA955
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1513364
—
TN
Enumeration date
06/01/2006
Last updated
04/02/2026
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