Provider Demographics
NPI:1437220886
Name:BLUM, JOHN KARL (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KARL
Last Name:BLUM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 WEST 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 WEST 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE4213207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10015408OtherAMERIGROUP
TX135117302OtherMEDICAID THSTEPS TPI
TX084042301OtherMEDICAID GROUP TPI
TX135117307OtherMEDICAID IND. TPI
TXD75099Medicare UPIN
TX10015408OtherAMERIGROUP