Provider Demographics
NPI:1073509535
Name:BLUM, STUART LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:LOUIS
Last Name:BLUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 E BERT KOUN LOOP
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5740
Mailing Address - Country:US
Mailing Address - Phone:318-212-3858
Mailing Address - Fax:318-212-3958
Practice Address - Street 1:1811 E BERT KOUN LOOP
Practice Address - Street 2:SUITE 110
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5740
Practice Address - Country:US
Practice Address - Phone:318-212-3858
Practice Address - Fax:318-212-3958
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2015-08-18
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
LA07432R174400000X
LAMD.07432R207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1389749Medicaid
LA1389749Medicaid
LAB64410Medicare UPIN
LA53146Medicare ID - Type UnspecifiedMEDICARE