Dr. Mitchell Edward Blum
Otolaryngologist (ENT Doctor) Facial Plastic Surgeon
2160 W. Grantline Rd Suite 250
Tracy
, California 95377
Dr. Mitchell Edward Blum
Otolaryngologist (ENT Doctor) Facial Plastic Surgeon
2160 W. Grantline Rd Suite 250
Tracy
, California 95377
(510) 817-4235
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About
Features
Specialties
- Otolaryngologist (ENT Doctor)
- Facial Plastic Surgeon
Languages spoken
- English
Location
First Address
- Dr. Mitchell Edward Blum
- 15 Oval Rd
- Oakland, CA
- Zip : 94611
- Fax : (510) 817-4235
- Phone : (209) 834-0626
Second Address
- Dr. Mitchell Edward Blum
- 2160 W. Grantline Rd Suite 250
- Tracy, CA
- Zip : 95377
- Fax : (209) 834-1814
- Phone : (209) 834-0626
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207Y00000X | Otolaryngologist (ENT Doctor) | G25010 | CA |
| N | 207YS0123X | Facial Plastic Surgeon | G25010 | CA |
National Provider Identifier
| NPI | 1770586448 |
|---|---|
| Provider Name | Dr. Mitchell Edward Blum |
| First Address | Oakland, CA 94611 |
| Second Address | Tracy, CA 95377 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 24/05/2005 |
| Last Update Date | 30/04/2015 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 00G250100 | (05) | CA |
| A42480 | (02) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.