Provider Demographics
NPI:1144315128
Name:BLISARD, KAREN S (PHD MD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:S
Last Name:BLISARD
Suffix:
Gender:F
Credentials:PHD MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1313 E 32ND ST
Mailing Address - Street 2:LABORATORY
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-7251
Mailing Address - Country:US
Mailing Address - Phone:575-538-4058
Mailing Address - Fax:
Practice Address - Street 1:1313 E 32ND ST
Practice Address - Street 2:LABORATORY
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-7251
Practice Address - Country:US
Practice Address - Phone:575-538-4058
Practice Address - Fax:575-574-4992
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM84-10207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMI5782Medicaid
NMI5782Medicaid