Provider Demographics
NPI:1114201654
Name:BLUME, ROBERT D (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:D
Last Name:BLUME
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 MED CT STE 210
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3484
Mailing Address - Country:US
Mailing Address - Phone:210-494-4290
Mailing Address - Fax:210-494-4809
Practice Address - Street 1:510 MED CT STE 210
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3484
Practice Address - Country:US
Practice Address - Phone:210-494-4290
Practice Address - Fax:210-494-4809
Is Sole Proprietor?:No
Enumeration Date:2011-10-03
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA13426363A00000X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant