Blue, Brent

Blue, Brent is an sole proprietor health care provider with primary practice located at 555 E Broadway Ave Ste 207 , Jackson WY 83001-8640. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Emergency Medicine, Ambulatory Health Care Facilities / Urgent Care, Allopathic & Osteopathic Physicians / Family Medicine. Allopathic & Osteopathic Physicians / Family Medicine is his primary health care specialty. Blue, Brent can be contacted via phone (307) 733-8002.

Contact Information

Primary practice address
555 E Broadway Ave Ste 207 Jackson WY 83001-8640
Phone: (307) 733-8002
Fax: (307) 739-4811
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X A31472 California
Ambulatory Health Care Facilities / Urgent Care 261QU0200X 3416A Wyoming
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 3416A Wyoming

Profile Details

NPI number 1063467538
LBN Legal business name Blue, Brent
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 23rd, 2006
Last updated Jan 23rd, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1063467538 NPPES
Wyoming MEDICAID 102017000

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