Provider Demographics
NPI:1194024992
Name:D&K BLY INTERNATIONAL LLC
Entity Type:Organization
Organization Name:D&K BLY INTERNATIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:3057-358-3920
Mailing Address - Street 1:1614 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-3515
Mailing Address - Country:US
Mailing Address - Phone:305-735-3920
Mailing Address - Fax:305-328-8304
Practice Address - Street 1:1614 SOUTH ST
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-3515
Practice Address - Country:US
Practice Address - Phone:305-735-3920
Practice Address - Fax:305-328-8304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-18
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10451208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLES832AMedicare Oscar/Certification