Provider Demographics
NPI:1598987240
Name:NOAH M BLUM DPM PA
Entity Type:Organization
Organization Name:NOAH M BLUM DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:NOAH
Authorized Official - Middle Name:M
Authorized Official - Last Name:BLUM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:772-489-4343
Mailing Address - Street 1:2316 NEBRASKA AVE
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4824
Mailing Address - Country:US
Mailing Address - Phone:772-489-4343
Mailing Address - Fax:772-489-4543
Practice Address - Street 1:2316 NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4824
Practice Address - Country:US
Practice Address - Phone:772-489-4343
Practice Address - Fax:772-489-4543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP02942213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340315700Medicaid
FL6156560001Medicare NSC