Provider Demographics
NPI:1023721941
Name:BLASER MEDICAL LLC
Entity type:Organization
Organization Name:BLASER MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTING/CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ALLISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-391-6617
Mailing Address - Street 1:116 S SHADOW BREEZE RD
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-9401
Mailing Address - Country:US
Mailing Address - Phone:801-515-7997
Mailing Address - Fax:385-333-7413
Practice Address - Street 1:475 40TH ST STE 111
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-1856
Practice Address - Country:US
Practice Address - Phone:801-515-7997
Practice Address - Fax:385-333-7413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-05
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty