MEDICARE: DR. JOHN COLEY 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	207RH0003X	Hematology & Oncology Physician	4226	AL

General Provider Information

NPI Number	:	1790998508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN COLEY BLYTHE M.D.

Provider Business Mailing Address
First Line	:	3185 HIGHWAY 22 WEST
Second Line	:
City	:	ALEXANDER CITY
State	:	AL
Zip	:	35010
Country	:	US
Telephone Number	:	256-329-2640
Fax Number	:

Provider Business Practice Location Address
First Line	:	3185 HIGHWAY 22 WEST
Second Line	:
City	:	ALEXANDER CITY
State	:	AL
Zip	:	35010
Country	:	US
Telephone Number	:	256-329-2640
Fax Number	:

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

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	07/08/2007

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