Provider Demographics
NPI:1386737526
Name:BLAINE, JAMES READ (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:READ
Last Name:BLAINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1355 E CRYSTAL HILL LANE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803
Mailing Address - Country:US
Mailing Address - Phone:417-833-3831
Mailing Address - Fax:
Practice Address - Street 1:815 N SHERMAN AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-3757
Practice Address - Country:US
Practice Address - Phone:417-866-3133
Practice Address - Fax:417-866-3233
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR7631207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200482032Medicaid
E38710Medicare UPIN