Provider Demographics
NPI:1346207792
Name:BLEVINS, FIELD T (MD)
Entity Type:Individual
Prefix:
First Name:FIELD
Middle Name:T
Last Name:BLEVINS
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 1:575 RIVERGATE LANE
Mailing Address - Street 2:STE 105
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301
Mailing Address - Country:US
Mailing Address - Phone:970-259-3020
Mailing Address - Fax:970-259-9766
Practice Address - Street 1:575 RIVERGATE LANE
Practice Address - Street 2:STE 105
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301
Practice Address - Country:US
Practice Address - Phone:970-259-3020
Practice Address - Fax:970-259-9766
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO31119207XX0005X
NM93-216207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO14674041Medicaid
E85582Medicare UPIN
CO14674041Medicaid