Provider Demographics
NPI:1194748715
Name:BLASKO, JOHN C (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:BLASKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3972
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-3972
Mailing Address - Country:US
Mailing Address - Phone:206-749-5130
Mailing Address - Fax:206-749-5135
Practice Address - Street 1:1101 MADISON, SUITE 1101
Practice Address - Street 2:C/O SEATTLE PROSTATE INSTITUTE
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104
Practice Address - Country:US
Practice Address - Phone:206-215-2480
Practice Address - Fax:206-215-2481
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000160982085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8149080Medicaid
WAAB04886Medicare PIN
WAA14697Medicare UPIN