Provider Demographics
NPI:1366843815
Name:BLUE, STEPHEN DUAME
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:DUAME
Last Name:BLUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2748 TUNNEL ST
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-3427
Mailing Address - Country:US
Mailing Address - Phone:702-683-0242
Mailing Address - Fax:
Practice Address - Street 1:2748 TUNNEL ST
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-3427
Practice Address - Country:US
Practice Address - Phone:702-683-0242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-15
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker