MEDICARE: DR. DONALD STINSON BLYTHE 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	207P00000X	Emergency Medicine Physician	C37048	CA

General Provider Information

NPI Number	:	1740201227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD STINSON BLYTHE M.D.

Provider Business Mailing Address
First Line	:	4948 SAN JUAN AVE
Second Line	:
City	:	FAIR OAKS
State	:	CA
Zip	:	95628-4606
Country	:	US
Telephone Number	:	916-966-6287
Fax Number	:	916-966-2541

Provider Business Practice Location Address
First Line	:	4948 SAN JUAN AVE
Second Line	:
City	:	FAIR OAKS
State	:	CA
Zip	:	95628-4606
Country	:	US
Telephone Number	:	916-966-6287
Fax Number	:	916-966-2541

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	03/06/2010

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