Provider Demographics
NPI:1548402506
Name:BLAU, JILL C (DPM)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:C
Last Name:BLAU
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CELADON DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29907-2695
Mailing Address - Country:US
Mailing Address - Phone:843-379-9913
Mailing Address - Fax:843-379-9914
Practice Address - Street 1:40 OKATIE CTR BLVD STE 205
Practice Address - Street 2:
Practice Address - City:OKATIE
Practice Address - State:SC
Practice Address - Zip Code:29909-7511
Practice Address - Country:US
Practice Address - Phone:843-379-9913
Practice Address - Fax:843-379-9914
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC591213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC6306950001Medicare NSC