Provider Demographics
NPI:1447271234
Name:BLASCHKE, DONALD GLEN II (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:GLEN
Last Name:BLASCHKE
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8161 HIGHWAY 100 STE 299
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37221-4213
Mailing Address - Country:US
Mailing Address - Phone:615-979-9453
Mailing Address - Fax:
Practice Address - Street 1:601 E ROLLINS ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1248
Practice Address - Country:US
Practice Address - Phone:407-303-6413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2650207P00000X
FL155690207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AP260OtherBCBS
TX8F8875OtherBCBS
TX122165712Medicaid
TX122165711Medicaid
TX122165713Medicaid
LA1314773Medicaid
TX8B7203Medicare PIN
TX122165712Medicaid
TX122165711Medicaid
TX8F6356Medicare PIN
TX8B7203Medicare ID - Type UnspecifiedPROVIDER #
LA1314773Medicaid