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Individual

LEE G BLAND

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
22 HARTFORD ST, HOULTON, ME 04730-1891
(859) 224-9581
(859) 224-9497
Mailing address
22 HARTFORD ST, HOULTON, ME 04730-1891
(859) 224-9581
(859) 224-9497

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA022
KY
363AM0700X
Medical Physician Assistant
PA022
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
37903705
MEDICAID LAB GROUP
KY
01
4000501
MEDICARE LAB GROUP
KY
05
95000220
KY
01
CB5773
RR MEDICARE LAB GROUP
KY
Enumeration date
10/04/2006
Last updated
05/06/2020
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