Provider Demographics
NPI:1992155980
Name:BLAU, CAITLIN MARIE (DO)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:MARIE
Last Name:BLAU
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1050 LARRABEE AVE STE 104
Mailing Address - Street 2:PMB 480
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225
Mailing Address - Country:US
Mailing Address - Phone:425-233-4785
Mailing Address - Fax:406-543-9890
Practice Address - Street 1:1530 ELLIS ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4905
Practice Address - Country:US
Practice Address - Phone:360-734-9095
Practice Address - Fax:360-715-8416
Is Sole Proprietor?:No
Enumeration Date:2016-06-21
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MT76122207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program