Basic Information
| Provider Information | |||||||||
| NPI: | 1942303391 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLUE | ||||||||
| FirstName: | ALFRED | ||||||||
| MiddleName: | ISAIAH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1221 MADISON | ||||||||
| Address2: | #1520 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062926226 | ||||||||
| FaxNumber: | 2066238825 | ||||||||
| Practice Location | |||||||||
| Address1: | 1221 MADISON | ||||||||
| Address2: | #1520 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062926226 | ||||||||
| FaxNumber: | 2066238825 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0106X | MD00008056 | WA | X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery | 2086S0122X | MD00008056 | WA | X | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery |
No ID Information.