Provider Demographics
NPI:1508845736
Name:BLUMBERG, JOEL SAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:SAUL
Last Name:BLUMBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:205 E UNIVERSITY AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-6821
Mailing Address - Country:US
Mailing Address - Phone:512-686-0207
Mailing Address - Fax:
Practice Address - Street 1:4849 CALHOUN RD.
Practice Address - Street 2:HEALTH 2 BUILDING, SUITE #1001-A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77204-6066
Practice Address - Country:US
Practice Address - Phone:877-800-5722
Practice Address - Fax:713-481-1730
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH7907208000000X
AZ44261208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE82249Medicare UPIN