Provider Demographics
NPI:1437181054
Name:BLAYDES, STEPHEN HILL (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:HILL
Last Name:BLAYDES
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 1:1109 W CUMBERLAND RD
Mailing Address - Street 2:PO BOX 1380
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-4562
Mailing Address - Country:US
Mailing Address - Phone:304-327-8128
Mailing Address - Fax:304-327-5912
Practice Address - Street 1:1109 W CUMBERLAND RD
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-4562
Practice Address - Country:US
Practice Address - Phone:304-327-8128
Practice Address - Fax:304-327-5912
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV175974207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
180031610OtherRR MEDICARE
WV0095897000Medicaid
180031610OtherRR MEDICARE
WV0095897000Medicaid
WVF75169Medicare UPIN
VA190001544Medicare PIN