Provider Demographics
NPI:1710202965
Name:BLUM, MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:BLUM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1887 KINGSLEY AVE STE 1900
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4451
Mailing Address - Country:US
Mailing Address - Phone:904-276-2549
Mailing Address - Fax:904-276-9223
Practice Address - Street 1:1887 KINGSLEY AVE STE 1900
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4451
Practice Address - Country:US
Practice Address - Phone:904-276-2549
Practice Address - Fax:904-276-9223
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2024-01-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME1630072086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care