Provider Demographics
NPI:1467424614
Name:BLUMENTHAL, BARRY M (DO)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:M
Last Name:BLUMENTHAL
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 1:9700 NE 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138-2311
Mailing Address - Country:US
Mailing Address - Phone:786-360-2800
Mailing Address - Fax:786-360-2890
Practice Address - Street 1:9700 NE 2ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-2311
Practice Address - Country:US
Practice Address - Phone:786-360-2800
Practice Address - Fax:786-360-2890
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6342207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370348700Medicaid
FL80635Medicare ID - Type Unspecified
FL370348700Medicaid