Active NPI
Bruce Blyth, M.D.
- Pediatric Urology Physician
- Denver, CO
National Provider Identifier
1174587265
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Urology Physician
- License
- 31504
- Practice address
- 1601 E 19TH Ave
Suite 3750
Denver, CO 80218-1216 - Phone
- (303) 839-7200
- Fax
- (303) 839-7229
- NPI assigned
- Apr 14, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Urology Physician | 2088P0231X | 31504 | CO | Primary |
Addresses
Primary practice location
1601 E 19TH Ave
Suite 3750
Denver, CO 80218-1216
Mailing address
1601 E 19TH Ave
Suite 3750
Denver, CO 80218-1216
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01315043 | Medicaid | CO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 31504 | CO | MD | Pediatric Urology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144972800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1174587265",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1601 E 19TH AVE",
"address_2": "SUITE 3750",
"city": "DENVER",
"state": "CO",
"postal_code": "802181216"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1601 E 19TH AVE",
"address_2": "SUITE 3750",
"city": "DENVER",
"state": "CO",
"postal_code": "802181216",
"telephone_number": "303-839-7200",
"fax_number": "303-839-7229"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLYTH",
"first_name": "BRUCE",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2088P0231X",
"taxonomy_group": "",
"desc": "Urology, Pediatric Urology",
"state": "CO",
"license": "31504",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01315043",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Denver, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.