Healthcare Provider Details

I. General information

NPI: 1770361461
Provider Name (Legal Business Name): TAYLOR RUTH BLOW PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2023
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MCRD PARRIS ISLAND MEDICAL CLINIC 670 BOULEVARD DE FRANCE
FPO AA
29902
US

IV. Provider business mailing address

MCRD PARRIS ISLAND MEDICAL CLINIC 670 BOULEVARD DE FRANCE
FPO AA
29902
US

V. Phone/Fax

Practice location:
  • Phone: 843-228-2811
  • Fax:
Mailing address:
  • Phone: 843-228-2811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: