Individual
WAYNE BLEVINS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11574 RT 108, CARLINVILLE, IL 62626-4091
(217) 854-4319
(217) 854-2765
Mailing address
715 BROADWAY ST, GILLESPIE, IL 62033-1166
(217) 839-4491
(205) 313-5299
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
PA2642
FL
363A00000X
Physician Assistant
085004267
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
606478700
DEPT OF LABOR
FL
01
—
96317
HEALTH PARTNERS
FL
05
—
U4077Z
—
FL
Enumeration date
07/06/2005
Last updated
04/23/2015
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