# BLUE HERON MEDICAL GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1861686313
- **Authorized official:** DR. PAUL REARDON FLEURY M.D. (DOCTOR)
- **Authorized official phone:** (410) 957-3005

## Contact information

- **Practice address:** 305 10TH ST, STE 101, POCOMOKE CITY, MD 21851-1607
- **Practice address phone:** (410) 957-3005
- **Practice address fax:** (410) 957-0550
- **Mailing address:** 305 10TH ST, STE 101, POCOMOKE CITY, MD 21851-1607
- **Mailing address phone:** (410) 957-3005
- **Mailing address fax:** (410) 957-0550

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | D058928 | MD | — |
| 207Q00000X | Family Medicine Physician | D45995 | MD | — |
| 207R00000X | Internal Medicine Physician | D24871 | MD | — |
| 207R00000X | Internal Medicine Physician | D24872 | MD | Yes |
| 207R00000X | Internal Medicine Physician | D36576 | MD | — |
| 363LF0000X | Family Nurse Practitioner | Q37875 | MD | — |

## Other

- **Enumeration date:** 08/28/2007
- **Last updated:** 03/01/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1245292853 | NPI | MD |
| 01 | — | 1265491286 | NPI | MD |
| 01 | — | 1639269368 | NPI | MD |
| 01 | — | 1669558227 | NPI | MD |
| 01 | — | 1841384625 | NPI | MD |
| 01 | — | 1992764815 | NPI | MD |