Organization
BLUE PLASTIC SURGERY CENTER PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARTIN LUTHER BLUE M.D. (PHYSICIAN/OWNER)
(704) 235-6610
Entity
Organization
Contact information
Practice address
134 PROFESSIONAL PARK DR, SUITE 200, MOORESVILLE, NC 28117-5599
(704) 235-6610
(704) 235-6615
Mailing address
134 PROFESSIONAL PARK DR, SUITE 200, MOORESVILLE, NC 28117-5599
(704) 235-6610
(704) 235-6615
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
2005-1317
NC
Other
Enumeration date
11/04/2008
Last updated
06/04/2009
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