Provider Demographics
NPI:1093794851
Name:BLUE, MARY C (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:C
Last Name:BLUE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:14275 MIDWAY RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3614
Mailing Address - Country:US
Mailing Address - Phone:214-932-8029
Mailing Address - Fax:610-271-4245
Practice Address - Street 1:1620 MEDICAL LN
Practice Address - Street 2:SUITE 100
Practice Address - City:FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1143
Practice Address - Country:US
Practice Address - Phone:239-939-2305
Practice Address - Fax:239-939-0947
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2015-04-23
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Provider Licenses
StateLicense IDTaxonomies
FLME47480207ZP0102X, 207ZC0500X, 207ZM0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No207ZM0300XAllopathic & Osteopathic PhysiciansPathologyMedical Microbiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374110900Medicaid
FLD54515Medicare UPIN
FL36418UMedicare PIN