1316956063 NPI number — DR. DEBRA L BLUE MD

Table of content: DR. DEBRA L BLUE MD (NPI 1316956063)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316956063 NPI number — DR. DEBRA L BLUE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLUE
Provider First Name:
DEBRA
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316956063
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
146 COUNTRY MILL WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FUQUAY VARINA
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27526-7389
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-828-0890
Provider Business Mailing Address Fax Number:
919-719-0395

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 HOSPICE CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27607-6372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-828-0890
Provider Business Practice Location Address Fax Number:
919-719-0395
Provider Enumeration Date:
08/05/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207QH0002X , with the licence number:  2008-00920 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)