Individual
JACOB CLARENCE BLAZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1234 NAPIER AVE, SAINT JOSEPH, MI 49085-2112
(269) 985-4632
(269) 985-4623
Mailing address
1234 NAPIER AVE, SAINT JOSEPH, MI 49085-2112
(269) 985-4632
(269) 985-4535
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
5101020805
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1861716748
—
MI
01
—
5110085
BCBS
MI
Enumeration date
03/21/2010
Last updated
05/19/2015
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