Healthcare Provider Details

I. General information

NPI: 1801900220
Provider Name (Legal Business Name): JEFFREY G BLUE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 E HACIENDA AVE STE C
CAMPBELL CA
95008-6625
US

IV. Provider business mailing address

221 E HACIENDA AVE STE C
CAMPBELL CA
95008-6625
US

V. Phone/Fax

Practice location:
  • Phone: 408-404-4700
  • Fax: 408-404-4701
Mailing address:
  • Phone: 408-404-4700
  • Fax: 408-404-4701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberA060369
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: