Provider Demographics
NPI:1174621247
Name:BLAZEK, AMY A (PA)
Entity type:Individual
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First Name:AMY
Middle Name:A
Last Name:BLAZEK
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Gender:F
Credentials:PA
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Mailing Address - Street 1:5219 CITY BANK PKWY
Mailing Address - Street 2:STE 35
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-3544
Mailing Address - Country:US
Mailing Address - Phone:806-785-7676
Mailing Address - Fax:806-785-0872
Practice Address - Street 1:3502 9TH ST
Practice Address - Street 2:STE 110
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415-3300
Practice Address - Country:US
Practice Address - Phone:806-744-1171
Practice Address - Fax:806-744-1169
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant