Provider Demographics
NPI:1356469092
Name:JOHN K BLUM
Entity Type:Organization
Organization Name:JOHN K BLUM
Other - Org Name:MY FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:KARL
Authorized Official - Last Name:BLUM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:713-802-4357
Mailing Address - Street 1:1618 W 18TH ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1525
Mailing Address - Country:US
Mailing Address - Phone:713-802-4357
Mailing Address - Fax:713-802-2659
Practice Address - Street 1:1618 W 18TH ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1525
Practice Address - Country:US
Practice Address - Phone:713-802-4357
Practice Address - Fax:713-802-2659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4213207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD75099Medicare UPIN