Provider Demographics
NPI:1952300949
Name:BLYTHE, STEPHEN EARL (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:EARL
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 1:4950 S LE JEUNE RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-2231
Mailing Address - Country:US
Mailing Address - Phone:305-667-0660
Mailing Address - Fax:305-667-2270
Practice Address - Street 1:4950 S LE JEUNE RD
Practice Address - Street 2:SUITE G
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2231
Practice Address - Country:US
Practice Address - Phone:305-667-0660
Practice Address - Fax:305-667-2270
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLM22256207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD79546Medicare UPIN
FL92819ZMedicare ID - Type Unspecified