Provider Demographics
NPI:1396205423
Name:BLUTSTEIN, SCOTT JEFFRY (DPM)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:JEFFRY
Last Name:BLUTSTEIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10578 SW CAPRAIA WAY
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2885
Mailing Address - Country:US
Mailing Address - Phone:917-923-1067
Mailing Address - Fax:
Practice Address - Street 1:10578 SW CAPRAIA WAY
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-2885
Practice Address - Country:US
Practice Address - Phone:917-923-1067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-24
Last Update Date:2019-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP01419213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine