MEDICARE: RICHARD H BLUE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	027348	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	024215	OTHER	GA	BLUE CROSS BLUE SHEILD

General Provider Information

NPI Number	:	1033118096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD H BLUE M.D.

Provider Business Mailing Address
First Line	:	1747 LANGFORD DR
Second Line	:	BUILDING 400, SUITE 101
City	:	BOGART
State	:	GA
Zip	:	30622-2610
Country	:	US
Telephone Number	:	706-549-0005
Fax Number	:	706-850-3180

Provider Business Practice Location Address
First Line	:	1747 LANGFORD DR
Second Line	:	BUILDING 400, SUITE 101
City	:	BOGART
State	:	GA
Zip	:	30622-2610
Country	:	US
Telephone Number	:	706-549-0005
Fax Number	:	706-850-3180

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	02/24/2014

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