Provider Demographics
NPI:1295839595
Name:BLUM, BARRY (MD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:
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 1:78-6831 ALI'I DRIVE
Mailing Address - Street 2:SUITE 328
Mailing Address - City:KAILUA-KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740
Mailing Address - Country:US
Mailing Address - Phone:808-747-8321
Mailing Address - Fax:808-331-8682
Practice Address - Street 1:78-6831 ALI'I DRIVE
Practice Address - Street 2:SUITE 328
Practice Address - City:KAILUA-KONA
Practice Address - State:HI
Practice Address - Zip Code:96740
Practice Address - Country:US
Practice Address - Phone:808-747-8321
Practice Address - Fax:808-322-6005
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD3340207X00000X
CAG15800207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00024190OtherHMSA
HI21856Medicaid
H103642Medicare PIN
HI21856Medicaid
HI0000BDMGTMedicare PIN
HI00024190OtherHMSA