Provider Demographics
NPI:1174589527
Name:BLYTHE, JASON MCLAIN (DPM)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:MCLAIN
Last Name:BLYTHE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2480 MISSION ST
Mailing Address - Street 2:#327
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-2468
Mailing Address - Country:US
Mailing Address - Phone:415-824-3737
Mailing Address - Fax:415-824-2107
Practice Address - Street 1:2480 MISSION ST STE 327
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-2463
Practice Address - Country:US
Practice Address - Phone:415-824-3737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4637213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5723780001OtherDME SUPPLIER NUMBER
CA1174589527OtherNPI NUMBER
CA5723780001Medicare NSC
CA1174589527OtherNPI NUMBER
CA000E46370Medicare PIN