Provider Demographics
NPI:1245207315
Name:BLUMER, JOHN R (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:BLUMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6035 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3256
Mailing Address - Country:US
Mailing Address - Phone:704-295-3000
Mailing Address - Fax:704-838-8494
Practice Address - Street 1:6035 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3256
Practice Address - Country:US
Practice Address - Phone:704-295-3000
Practice Address - Fax:704-838-8494
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC35841207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC11317OtherDOCTORS HEALTH PLAN
141024OtherCOVENTRY HEALTHCARE HMO
NC16393OtherBCBS
9466OtherPARTNERS SELECT CARE
SCN35841Medicaid
SC01146087OtherAMERIGROUP COMMUNITY CARE
SC20087248OtherSELECT HEALTH OF SC/FIRST CHOICE
4570715OtherAETNA
276567OtherMAMSI
NC8916393Medicaid
NC44672OtherMEDCOST
NC26674OtherWELLPATH
SC771567OtherWELLCARE
NC5703439003OtherCIGNA
NC11317OtherDOCTORS HEALTH PLAN
E68696Medicare UPIN
2174912CMedicare ID - Type Unspecified