Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 373429-1205 | UT |
NPI | 1003836024 |
---|---|
Provider Name | Jeffery L Bleazard |
First Address | Cedar City, UT 84720-9746 |
Second Address | Cedar City, UT 84720-9746 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 08/07/2007 |