Provider Demographics
NPI:1790087955
Name:BLUMBERG, PAUL (DO)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:BLUMBERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10135 E WETHERSFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-5132
Mailing Address - Country:US
Mailing Address - Phone:602-980-0174
Mailing Address - Fax:
Practice Address - Street 1:10135 E WETHERSFIELD RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-5132
Practice Address - Country:US
Practice Address - Phone:602-980-0174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-21
Last Update Date:2010-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1597207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery