Provider Demographics
NPI:1316956063
Name:BLUE, DEBRA L (MD)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:L
Last Name:BLUE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:146 COUNTRY MILL WAY
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-7389
Mailing Address - Country:US
Mailing Address - Phone:919-828-0890
Mailing Address - Fax:919-719-0395
Practice Address - Street 1:250 HOSPICE CIR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6372
Practice Address - Country:US
Practice Address - Phone:919-828-0890
Practice Address - Fax:919-719-0395
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-00920207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F25144Medicare UPIN
651850024Medicare ID - Type UnspecifiedMEDICARE PROVIDER