Provider Demographics
NPI:1285991703
Name:BLASSER, CATHERINE JEAN (DO)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:JEAN
Last Name:BLASSER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:CATHERINE
Other - Middle Name:JEAN
Other - Last Name:HENDERSHOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:45TH MEDICAL GROUP
Mailing Address - Street 2:1381 SOUTH PATRICK DR
Mailing Address - City:PATRICK AFB
Mailing Address - State:FL
Mailing Address - Zip Code:32925
Mailing Address - Country:US
Mailing Address - Phone:321-494-8241
Mailing Address - Fax:
Practice Address - Street 1:1350 HICKORY ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3224
Practice Address - Country:US
Practice Address - Phone:321-434-1771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-22
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS21383207R00000X, 208M00000X
OH34.013196207R00000X, 2083A0100X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL123922200Medicaid
OH0313124Medicaid
FLTO168OtherMEDICARE HF