Provider Demographics
NPI:1578872917
Name:J. FREDRICK BLUHM III, MD, SC
Entity Type:Organization
Organization Name:J. FREDRICK BLUHM III, MD, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:FREDRICK
Authorized Official - Last Name:BLUHM
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:660-827-2034
Mailing Address - Street 1:1431 THOMPSON BLVD.
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-2244
Mailing Address - Country:US
Mailing Address - Phone:660-827-2034
Mailing Address - Fax:
Practice Address - Street 1:1431 THOMPSON BLVD.
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-2244
Practice Address - Country:US
Practice Address - Phone:660-827-2034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-04
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6A34207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0004637Medicare PIN
E07762Medicare UPIN