Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 1597 | AZ |
NPI | 1790087955 |
---|---|
Provider Name | Paul Blumberg |
First Address | Scottsdale, AZ 85260-5132 |
Second Address | Scottsdale, AZ 85260-5132 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2010 |
Last Update Date | 21/11/2010 |