Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | P01419 | FL |
NPI | 1396205423 |
---|---|
Provider Name | Dr. Scott Jeffry Blutstein |
First Address | Port St Lucie, FL 34986-2885 |
Second Address | Port St Lucie, FL 34986-2885 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2019 |
Last Update Date | 24/03/2019 |