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Organization

B .GLENN BLAIR DPM P.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. JULIE M RUSSELL (OFFICE MANAGER)
(203) 929-5559
Entity
Organization

Contact information

Practice address
375 BRIDGEPORT AVE, SHELTON, CT 06484-3844
(203) 929-5559
(203) 929-5277
Mailing address
375 BRIDGEPORT AVE, SHELTON, CT 06484-3844
(203) 929-5559
(203) 929-5277

Taxonomy

Speciality
Code
Description
License number
State
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
000419
CT
213ER0200X
Radiology Podiatrist
000419
CT
213ES0131X
Foot Surgery Podiatrist
000419
CT
332B00000X
Durable Medical Equipment & Medical Supplies
CT000419
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
004176815
CT
Enumeration date
12/18/2007
Last updated
04/02/2012
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