Provider Demographics
NPI:1306895222
Name:BLOUIN, GAYLE SMITH (MD)
Entity type:Individual
Prefix:
First Name:GAYLE
Middle Name:SMITH
Last Name:BLOUIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1 INDEPENDENCE PT
Mailing Address - Street 2:SUITE 212
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4545
Mailing Address - Country:US
Mailing Address - Phone:864-797-6044
Mailing Address - Fax:
Practice Address - Street 1:890 W FARIS RD
Practice Address - Street 2:SUITE 320
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4253
Practice Address - Country:US
Practice Address - Phone:864-455-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8461208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00265766OtherRR MEDICARE
SC4499170OtherAETNA
SC57-6007863085OtherBCBS OF SC
SCP00801312OtherRR MEDICARE
SC57-6007863119OtherBLUE CHOICE OF SC
SC084615Medicaid
SC1582357OtherCIGNA
SC57-6007863119OtherBLUE CHOICE OF SC
SCP00801312OtherRR MEDICARE
SC57-6007863085OtherBCBS OF SC