Provider Demographics
NPI:1699706408
Name:CARDIOTHORACIC SURGEON, PC
Entity type:Organization
Organization Name:CARDIOTHORACIC SURGEON, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BLIZZARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-388-1636
Mailing Address - Street 1:2705 NE CONNERS AVE
Mailing Address - Street 2:#100
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6904
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2705 NE CONNERS AVE
Practice Address - Street 2:#100
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6904
Practice Address - Country:US
Practice Address - Phone:541-388-1636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty