Provider Demographics
NPI:1558417345
Name:BLUM, KEITH S (DO)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:S
Last Name:BLUM
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Gender:M
Credentials:DO
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Mailing Address - Street 1:7271 WEST SAHARA
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2753
Mailing Address - Country:US
Mailing Address - Phone:702-240-4090
Mailing Address - Fax:702-240-4091
Practice Address - Street 1:7271 WEST SAHARA
Practice Address - Street 2:SUITE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117
Practice Address - Country:US
Practice Address - Phone:702-240-4090
Practice Address - Fax:702-240-4091
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2020-02-14
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Provider Licenses
StateLicense IDTaxonomies
NV1121207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100502549Medicaid
NV1456305995OtherBCBS
G80679Medicare UPIN