Basic Information
| Provider Information | |||||||||
| NPI: | 1174621247 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLAZEK | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5219 CITY BANK PKWY | ||||||||
| Address2: | STE 35 | ||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794073544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067857676 | ||||||||
| FaxNumber: | 8067850872 | ||||||||
| Practice Location | |||||||||
| Address1: | 3502 9TH ST | ||||||||
| Address2: | STE 110 | ||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794153300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067441171 | ||||||||
| FaxNumber: | 8067441169 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.