Provider Demographics
NPI:1346351616
Name:BLUM, NANCY A (DO)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:A
Last Name:BLUM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 CLEARWATER DR STE A
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-7166
Mailing Address - Country:US
Mailing Address - Phone:928-717-1600
Mailing Address - Fax:
Practice Address - Street 1:3105 CLEARWATER DR STE A
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-7166
Practice Address - Country:US
Practice Address - Phone:928-717-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4146207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ918401Medicaid
AZAZ0769710OtherBCBS PROV NUMBER
AZI15065Medicare UPIN
AZAZ0769710OtherBCBS PROV NUMBER