Basic Information
| Provider Information | |||||||||
| NPI: | 1134204662 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLATZ | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4095 AMERICAN WAY | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381188339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012719500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2574 FRAYSER BLVD | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381275829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012719500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2006 | ||||||||
| LastUpdateDate: | 11/18/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0106407A | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0200X | 23646 | MS | N | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 207RI0200X | 54902 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.