Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | LL28156 | SC |
N | 208600000X | Surgeon | LL28156 | SC |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 28156 | SC |
NPI | 1285718866 |
---|---|
Provider Name | Dr. Craig Ashley Blum |
First Address | Charleston, SC 29405-4999 |
Second Address | Summerville, SC 29483-6656 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 11/03/2019 |