Provider Demographics
NPI:1437194354
Name:BLIZZARD, DANIEL R (DO)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:R
Last Name:BLIZZARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CAUSEWAY DR STE 3
Mailing Address - Street 2:
Mailing Address - City:OCEAN ISLE BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28469-7581
Mailing Address - Country:US
Mailing Address - Phone:910-575-5004
Mailing Address - Fax:855-575-0700
Practice Address - Street 1:120 CAUSEWAY DR STE 3
Practice Address - Street 2:
Practice Address - City:OCEAN ISLE BEACH
Practice Address - State:NC
Practice Address - Zip Code:28469-7581
Practice Address - Country:US
Practice Address - Phone:910-575-5004
Practice Address - Fax:855-575-0700
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-01189207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036114617Medicaid
NC200701189OtherMEDICAL LICENSE
NC147N6OtherBCBS OF NC
NC5908511Medicaid
NC2075682Medicare PIN
NC200701189OtherMEDICAL LICENSE
IL036114617Medicaid