Provider Demographics
NPI:1619913670
Name:BLAIR W PYLE MD PC
Entity Type:Organization
Organization Name:BLAIR W PYLE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BLAIR
Authorized Official - Middle Name:W
Authorized Official - Last Name:PYLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-565-0876
Mailing Address - Street 1:1011 N MILDRED RD
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-9945
Mailing Address - Country:US
Mailing Address - Phone:970-565-0876
Mailing Address - Fax:970-565-3940
Practice Address - Street 1:1011 N MILDRED RD
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-9945
Practice Address - Country:US
Practice Address - Phone:970-565-0876
Practice Address - Fax:970-565-3940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24752207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COD24510Medicare UPIN