Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XS0106X | Orthopaedic Hand Surgeon | ME91320 | FL |
Y | 2086S0105X | Surgery of the Hand | ME91320 | FL |
NPI | 1801846373 |
---|---|
Provider Name | Louis Charles Blaum III |
First Address | Port Orange, FL 32128-6753 |
Second Address | New Smyrna Beach, FL 32168-7323 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 01/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I48818 | (02) | FL |