Provider Demographics
NPI:1598757056
Name:BLUMENFELD, SCOTT A (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:A
Last Name:BLUMENFELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1111 LOS JARDINES CIR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-1944
Mailing Address - Country:US
Mailing Address - Phone:915-204-6691
Mailing Address - Fax:915-217-2167
Practice Address - Street 1:10501 GATEWAY BLVD W
Practice Address - Street 2:SUITE A140
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7934
Practice Address - Country:US
Practice Address - Phone:915-313-7195
Practice Address - Fax:915-217-2167
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2015-05-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH79082085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136116409Medicaid
TX136116409Medicaid