Individual
DR. TARA L. F. BLASINGAME
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.P.M.
Contact information
Practice address
131 W DUBLIN DR, SUITE A, MADISON, AL 35758-1787
(256) 772-8566
(256) 774-8211
Mailing address
PO BOX 6487, HUNTSVILLE, AL 35813-0487
(256) 772-8566
(256) 774-8211
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
714
GA
213ES0131X
Foot Surgery Podiatrist
Primary
AL164
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051514658
BLUE CROSS BLUE SHIELD
AL
01
—
051514659
BLUE CROSS BLUE SHIELD
AL
01
—
510452548
TRICARE
AL
05
—
890010830
—
AL
05
—
890010840
—
AL
Enumeration date
11/16/2005
Last updated
03/28/2012
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