Provider Demographics
NPI:1730104233
Name:BLASINGAME, JENNIFER J (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:J
Last Name:BLASINGAME
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1602 ROCK PRAIRIE RD
Mailing Address - Street 2:SUITE 3000
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-8306
Mailing Address - Country:US
Mailing Address - Phone:979-764-4043
Mailing Address - Fax:979-694-2175
Practice Address - Street 1:1602 ROCK PRAIRIE RD
Practice Address - Street 2:SUITE 3000
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-8306
Practice Address - Country:US
Practice Address - Phone:979-764-4043
Practice Address - Fax:979-694-2175
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3243207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160054934OtherMEDICARE RAILROAD
TX147518801Medicaid
TX8308N1OtherBLUE CROSS BLUE SHIELD OF TEXAS
TX160054934OtherMEDICARE RAILROAD
TX8308N1Medicare PIN