Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 000014 | CT |
NPI | 1386719961 |
---|---|
Provider Name | James Howard Blume |
First Address | New Haven, CT 06515-1287 |
Second Address | New Haven, CT 06515-1287 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4004511 | (05) | CT |
T22745 | (02) | CT |