Provider Demographics
NPI:1073568622
Name:BLUST, LINDA S (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:S
Last Name:BLUST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10900 W 44TH AVE UNIT 200
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-2742
Mailing Address - Country:US
Mailing Address - Phone:720-923-1239
Mailing Address - Fax:303-284-4082
Practice Address - Street 1:10900 W 44TH AVE
Practice Address - Street 2:STE 200
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-2761
Practice Address - Country:US
Practice Address - Phone:303-379-9371
Practice Address - Fax:303-284-4082
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0054925207R00000X
WI41309207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO46184864Medicaid
CO414354YN6COtherMEDICARE PTAN
WI004M 73-601Medicare PIN
WI004M 73-601Medicare PIN