Individual
SUSAN KELLY BLUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1001 WASHINGTON AVE, FORT WORTH, TX 76104-3049
(817) 334-7922
(817) 870-2144
Mailing address
1001 WASHINGTON AVE, FORT WORTH, TX 76104-3049
(817) 334-7922
(817) 870-2144
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
E1506
TX
Other
Enumeration date
12/30/2005
Last updated
05/11/2011
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