Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mr. Douglas Alan Blazer, PA

Individual provider Medical Physician Assistant · NPI 1104101823

Mr. Douglas Alan Blazer, PA is a Physician Assistant in Rockford, Illinois. Qualified in 2011, 15 years ago. Practices with Physicians Immediate Care North Chicago LLC, a 261-clinician group and accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
15
Licensed in
IL
In the registry since
2011
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

3475 S Alpine Rd
Rockford, IL 61109-2604
Phone: (815) 874-8000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence 085004130 (IL)

Record details

NPI number1104101823
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedOctober 13, 2011
Last updated in NPPESOctober 13, 2011

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2011 (15 years in practice)
Group practice Physicians Immediate Care North Chicago Llc — 261 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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