Jacob Ian Blazzard (NPI# 1326125485, PAC ID# 9335168392) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PHYSICIAN ASSISTANT.
| Nation Provider ID (NPI) | 1326125485 |
| PAC ID by PECOS | 9335168392 |
| Professional Enrollment ID | I20171109002003 |
| Full Name | Jacob Ian Blazzard |
| Organization Legal Name | GRITMAN MEDICAL CENTER INC |
| Address |
623 S Main St Suite 1 Moscow ID 83843-2983 |
| Phone Number | 2088822011 |
| Gender | M |
| Credential | PA |
| Graduation Year | 2005 |
| Primary Specialty | PHYSICIAN ASSISTANT |
| Group Practice PAC ID | 0941545784 |
| Number of Group Practice Members | 19 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 131327 | GRITMAN MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 623 S Main St, Suite 1, Moscow, ID 83843-2983 | 2088822011 | GRITMAN MEDICAL CENTER INC |
| Organization Legal Name | GRITMAN MEDICAL CENTER INC |
| Physicians | 33 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Jennifer A Seegmiller | Nurse Practitioner | Gritman Medical Center Inc | 700 S Main St, Moscow, ID 83843-3056 |
| Patricia Nicolle Marciano | Family Medicine | Gritman Medical Center Inc | 623 S Main St, Suite 1, Moscow, ID 83843-2983 |
| Carolyn J Shoemaker | Physician Assistant | Gritman Medical Center Inc | 804 S Washington St, Suite A, Moscow, ID 83843-3182 |
| Jacques Maurice Bouchard | Family Medicine | Gritman Medical Center Inc | 623 S Main St, Suite 1, Moscow, ID 83843-2983 |
| Helen M Shearer | Family Medicine | Gritman Medical Center Inc | 623 S Main St, Suite 1, Moscow, ID 83843-2983 |
| Terry N Amiel | General Practice | Gritman Medical Center Inc | 623 S Main St, Suite 1, Moscow, ID 83843-2983 |
| David B Wait | Psychiatry | Gritman Medical Center Inc | 412 S Main St, Troy, ID 83871-5009 |
| Wendy M Goodrich | Physician Assistant | Gritman Medical Center Inc | 623 S Main St, Suite 1, Moscow, ID 83843-2983 |
| Randall F Kloepfer | Internal Medicine | Gritman Medical Center Inc | 700 S Main St, Moscow, ID 83843-3056 |
| Jennifer A Grinage | Physician Assistant | Gritman Medical Center Inc | 412 S Main St, Troy, ID 83871-5009 |
| Street Address |
623 S MAIN ST SUITE 1 |
| City | MOSCOW |
| State | ID |
| Zip | 83843-2983 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Patricia Nicolle Marciano | Family Medicine | Gritman Medical Center Inc | 623 S Main St, Suite 1, Moscow, ID 83843-2983 |
| Jacques Maurice Bouchard | Family Medicine | Gritman Medical Center Inc | 623 S Main St, Suite 1, Moscow, ID 83843-2983 |
| Helen M Shearer | Family Medicine | Gritman Medical Center Inc | 623 S Main St, Suite 1, Moscow, ID 83843-2983 |
| Nigel H Campbell | Obstetrics/gynecology | Devlin and Huberty Ps | 623 S Main St, Suite 5, Moscow, ID 83843-2983 |
| Terry N Amiel | General Practice | Gritman Medical Center Inc | 623 S Main St, Suite 1, Moscow, ID 83843-2983 |
| Wendy M Goodrich | Physician Assistant | Gritman Medical Center Inc | 623 S Main St, Suite 1, Moscow, ID 83843-2983 |
| Huong A Trinh | Obstetrics/gynecology | Devlin and Huberty Ps | 623 S Main St, Suite 5, Moscow, ID 83843-2983 |
| Jacob Kent Christensen | Family Medicine | Gritman Medical Center Inc | 623 S Main St, Suite 1, Moscow, ID 83843-2983 |
| Belinda Roberts | Nurse Practitioner | Gritman Medical Center Inc | 623 S Main St, Suite 1, Moscow, ID 83843-2983 |
| Bryn E Parker | Family Medicine | Gritman Medical Center Inc | 623 S Main St, Suite 1, Moscow, ID 83843-2983 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Lennard P Zylstra | Clinical Social Worker | 317 W 6th St, Suite 208, Moscow, ID 83843-2387 | |
| Sara Bs Presol | Nurse Practitioner | Moscow Medical, P.a. | 213 N Main St, Moscow, ID 83843-2700 |
| Rodger Dean Robertson | Optometry | 213 N Main St, Moscow, ID 83843-2700 | |
| Raymond M Paz | Family Medicine | Moscow Medical, P.a. | 213 N Main St, Moscow, ID 83843-2700 |
| Deborah A.k. Collins | Family Medicine | Moscow Medical, P.a. | 213 N Main St, Moscow, ID 83843-2700 |
| Emily C Todd | Family Practice | Moscow Medical, P.a. | 213 N Main St, Moscow, ID 83843-2700 |
| George E Fiegel | Chiropractic | 102 S Washington St, Moscow, ID 83843-2842 | |
| Robert W Haug | Chiropractic | Haug Chiropractic P.C. | 102 S Washington St, Moscow, ID 83843-2842 |
| Francis K Spain | Family Medicine | Gritman Medical Center Inc | 623 S Main St, Suite 1, Moscow, ID 83843-2983 |
| Meghan Catherine Kusko | Family Medicine | Gritman Medical Center Inc | 623 S Main St, Suite 1, Moscow, ID 83843-2983 |
| Find all physicians in zip 83843 | |||
| City | MOSCOW |
| Zip Code | 83843 |
| Specialty | PHYSICIAN ASSISTANT |
| City + Specialty | MOSCOW + PHYSICIAN ASSISTANT |
Please comment or provide details below to improve the information on Jacob Ian Blazzard.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.