Provider Demographics
NPI:1730154881
Name:BLYDENBURGH, JOSEPH MERAN JR (PA)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:MERAN
Last Name:BLYDENBURGH
Suffix:JR
Gender:M
Credentials:PA
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Mailing Address - Street 1:2961 MOSSROCK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-5119
Mailing Address - Country:US
Mailing Address - Phone:210-731-4800
Mailing Address - Fax:210-731-4810
Practice Address - Street 1:2961 MOSSROCK
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-5119
Practice Address - Country:US
Practice Address - Phone:210-731-4800
Practice Address - Fax:210-731-4810
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2018-10-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA01457363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P49023Medicare UPIN