Provider Demographics
NPI:1689665903
Name:BLYTHE, JOSEPH A (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:A
Last Name:BLYTHE
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 1:3557 S GALLOWAY DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-6816
Mailing Address - Country:US
Mailing Address - Phone:901-371-6666
Mailing Address - Fax:901-324-6355
Practice Address - Street 1:3557 S GALLOWAY DR
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38111-6816
Practice Address - Country:US
Practice Address - Phone:901-371-6666
Practice Address - Fax:901-324-6355
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7632207RP1001X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3178722Medicaid
B03829Medicare UPIN
TN3178722Medicaid