Provider Demographics
NPI:1871539890
Name:BLUE, LEON ROBY (MD)
Entity type:Individual
Prefix:DR
First Name:LEON
Middle Name:ROBY
Last Name:BLUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 SANTA FE DR
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-6964
Mailing Address - Country:US
Mailing Address - Phone:501-279-9393
Mailing Address - Fax:
Practice Address - Street 1:711 SANTA FE DR
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-6964
Practice Address - Country:US
Practice Address - Phone:501-279-9393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC5038207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR104541001Medicaid
AR92-0812OtherMALP INS #
AR50534Medicare ID - Type Unspecified
AR92-0812OtherMALP INS #