Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 25MA06431000 | NJ |
NPI | 1154361285 |
---|---|
Provider Name | Dr. Karl R Blum |
First Address | Toms River, NJ 08755-8063 |
Second Address | Toms River, NJ 08755-8063 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 24/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G02580 | (02) | NJ |