Brent Blue MD

NPI 1063467538 - Emergency Medicine - 207P00000X

NPI Details
NPI 1063467538
Gender Male
Enumeration Date 05/23/2006
Last Updated 10/27/2007
Entity Type Individual
Active Over 11 years ago
Practice Location
JACKSON WY, 83001-5240, US
Phone (307) 733-8002
Business Location
PO BOX 15240
JACKSON WY, 83002-5240, US
Phone (307) 733-8002
Taxonomy Code 207P00000X
License State California
License Number A31472
Remove 1063467538 NPI Number

According to our database, Brent Blue MD NPI is 1063467538, taxonomy code is 207P00000X and license number is A31472, license state is located at California. Brent Blue MD physically located at 982 W Broadway, Jackson WY, 83001-5240. NPI Number Brent Blue MD has the Individual type.

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1063467538 NPI number is provided on an as is basis without warranty of any kind. 1063467538 is maintained by the National Plan & Provider Enumeration System. The contents of Brent Blue MD are for informational purposes only.