Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 000581 | CT |
Y | 222Z00000X | Podiatrist | 000581 | CT |
N | 213EP1101X | Primary Podiatric Medicine | 000581 | CT |
N | 213ES0103X | Foot & Ankle Surgery | 000581 | CT |
N | 213ES0131X | Foot Surgery | 000581 | CT |
NPI | 1376526814 |
---|---|
Provider Name | Peter A 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 | 29/11/2005 |
Last Update Date | 15/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004121414 | (05) | CT |
U42618 | (02) |