Provider Demographics
NPI:1902987027
Name:BLUE, JEFFREY G (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:G
Last Name:BLUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 CAISSON HILL ROAD
Mailing Address - Street 2:ATTN: MCXX-CLD-QM (CRED)
Mailing Address - City:FORT RILEY
Mailing Address - State:KS
Mailing Address - Zip Code:66442-5037
Mailing Address - Country:US
Mailing Address - Phone:785-239-8385
Mailing Address - Fax:785-239-7364
Practice Address - Street 1:600 CAISSON HILL ROAD
Practice Address - Street 2:ATTN: MCXX-CLD-QM (CRED)
Practice Address - City:FORT RILEY
Practice Address - State:KS
Practice Address - Zip Code:66442-5037
Practice Address - Country:US
Practice Address - Phone:785-239-8385
Practice Address - Fax:785-239-7364
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine