Provider Demographics
NPI:1003979188
Name:BLISS, LINDLEY T (MD)
Entity Type:Individual
Prefix:
First Name:LINDLEY
Middle Name:T
Last Name:BLISS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 29048
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038-9048
Mailing Address - Country:US
Mailing Address - Phone:602-615-5672
Mailing Address - Fax:602-978-0158
Practice Address - Street 1:350 W THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4409
Practice Address - Country:US
Practice Address - Phone:602-615-5672
Practice Address - Fax:902-978-0158
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ30397208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ759342Medicaid
AZAZ0733030OtherBLUE CROSS
AZP02958OtherPHOENIX HEALTH PLAN
AZP00070361OtherRAILROAD MEDICARE
AZ759342OtherMERCY CARE
AZ386619Medicaid
AZP02958OtherPHOENIX HEALTH PLAN
AZAZ0733030OtherBLUE CROSS