Provider Demographics
NPI:1063438869
Name:BLIXT, JEFFREY K (DO)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:K
Last Name:BLIXT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 N WEBER ST STE 260
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-7553
Mailing Address - Country:US
Mailing Address - Phone:719-896-4794
Mailing Address - Fax:719-896-5484
Practice Address - Street 1:1715 N WEBER ST STE 260
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-7553
Practice Address - Country:US
Practice Address - Phone:719-896-4794
Practice Address - Fax:719-896-5484
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2018-03-17
Deactivation Date:2008-10-16
Deactivation Code:
Reactivation Date:2009-02-27
Provider Licenses
StateLicense IDTaxonomies
CO38650207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO17204062Medicaid
COH29708Medicare UPIN
CO40875Medicare PIN