MEDICARE: ADRAIN B. BLOTNER MD PC

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	2084N0400X	Neurology Physician

General Provider Information

NPI Number	:	1740459817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADRAIN B. BLOTNER MD PC

Provider Business Mailing Address
First Line	:	PO BOX 1000 DEPT 217
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38148-0001
Country	:	US
Telephone Number	:	901-758-8145
Fax Number	:	901-309-8784

Provider Business Practice Location Address
First Line	:	6401 POPLAR AVE STE 316
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38119-4806
Country	:	US
Telephone Number	:	901-761-3255
Fax Number	:	901-309-8784

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. ADRIAN B BLOTNER
Credential	:	MD
Telephone Number	:	901-761-3255

Provider Enumeration Date	:	02/22/2008
Last Update Date	:	02/22/2008

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