Marcus Blue, DDS
Individual provider Active NPI Periodontics · Basalt, CO
NPI 1619274263 · NPPES record last updated Feb 17, 2011
Key facts
- NPI
- 1619274263
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Periodontics 1223P0300X
- License
- 10275 (CO)
- Practice address
- 227 Midland Avenue
Suite C-6
Basalt, CO 81621 - Phone
- (970) 927-1004
- NPI assigned
- Feb 17, 2011
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10275 | CO | MD | Periodontist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 10275 | CO | Yes |
Addresses
Primary practice location
227 Midland Avenue
Suite C-6
Basalt, CO 81621
Mailing address
227 Midland Ave
Suite C-6
Basalt, CO 81621-8114
Other providers in Basalt, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 17, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.