Provider Demographics
NPI:1700885704
Name:BLYTHE, DONNA GLAD (MD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:GLAD
Last Name:BLYTHE
Suffix:
Gender:F
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:305-661-0774
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:305-661-0774
Practice Address - Fax:305-667-2270
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME22255207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD79520Medicare UPIN
FL921892BMedicare ID - Type Unspecified