Provider Demographics
NPI:1215938683
Name:BLOIS, MARSDEN SCOTT IV (MD)
Entity type:Individual
Prefix:
First Name:MARSDEN
Middle Name:SCOTT
Last Name:BLOIS
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SCOTT
Other - Middle Name:
Other - Last Name:BLOIS
Other - Suffix:IV
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5450 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2709
Mailing Address - Country:US
Mailing Address - Phone:303-442-2395
Mailing Address - Fax:303-442-1073
Practice Address - Street 1:4743 ARAPAHOE AVE
Practice Address - Street 2:STE 201
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1113
Practice Address - Country:US
Practice Address - Phone:303-442-2395
Practice Address - Fax:303-442-1073
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7308207RC0000X
CODR.0034464207RA0001X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
G47521Medicare UPIN
TXTXB107010Medicare PIN
CO434745YLL6Medicare PIN
TX8493K1Medicare PIN
TX0432304-01Medicaid
TX8493K1Medicare PIN