Individual
RANDALL RICHARD BLOUIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 PATEWOOD DR, SUITE A350, GREENVILLE, SC 29615-3593
(864) 454-5110
(864) 454-5141
Mailing address
1 INDEPENDENCE PT, SUITE 212, GREENVILLE, SC 29615-4545
(864) 797-6044
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
8372
SC
2080P0008X
Pediatric Neurodevelopmental Disabilities Physician
Primary
8372
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
083723
—
SC
01
—
1385497
CIGNA
SC
01
—
4304559
AETNA
SC
01
—
57-6007863037
BLUE CHOICE OF SC
SC
01
—
57-6007863080
BCBS OF SC
SC
Enumeration date
05/08/2006
Last updated
07/24/2013
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