Provider Demographics
NPI:1568444115
Name:BLUM, PHILIP S (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:S
Last Name:BLUM
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 1:915 GESSNER RD STE 750
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2574
Mailing Address - Country:US
Mailing Address - Phone:713-333-6900
Mailing Address - Fax:713-333-6919
Practice Address - Street 1:915 GESSNER RD STE 750
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2574
Practice Address - Country:US
Practice Address - Phone:713-338-5616
Practice Address - Fax:713-704-3086
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ89172085N0700X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00X185OtherMEDICARE GROUP PTAN - BRAZORIA
TX153449704OtherMEDICAID GROUP TPI
TX036006703Medicaid
DB6392OtherRAILROAD MEDICARE GROUP PTAN
TX0035TDOtherBLUE CROSS BLUE SHIELD OF TEXAS GROUP RECORD NUMBER
P01049027OtherRR MDCR PTAN
TX00106WOtherMEDICARE GROUP PTAN - HARRIS
TX036006704Medicaid
TX8DC608OtherBLUE CROSS BLUE SHIELD OF TEXAS INDIVIDUAL RECORD NUMBER
TX153449704OtherMEDICAID GROUP TPI
P01049027OtherRR MDCR PTAN
G14070Medicare UPIN