Provider Demographics
NPI:1659389724
Name:BLUM, STEPHEN L (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:L
Last Name:BLUM
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3939 W GREEN OAKS BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-2784
Mailing Address - Country:US
Mailing Address - Phone:817-429-8327
Mailing Address - Fax:817-457-3739
Practice Address - Street 1:3939 W GREEN OAKS BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016-2784
Practice Address - Country:US
Practice Address - Phone:817-429-8327
Practice Address - Fax:817-457-3739
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2008-02-14
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Provider Licenses
StateLicense IDTaxonomies
TXG7916207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00QM07Medicare PIN