Provider Demographics
NPI:1801846373
Name:BLAUM, LOUIS CHARLES III (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:CHARLES
Last Name:BLAUM
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1648 TAYLOR RD # 606
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-6753
Mailing Address - Country:US
Mailing Address - Phone:813-313-8013
Mailing Address - Fax:
Practice Address - Street 1:410 PALMETTO ST
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-7323
Practice Address - Country:US
Practice Address - Phone:386-267-6224
Practice Address - Fax:386-703-2304
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2020-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91320207XS0106X, 2086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Single Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI48818Medicare UPIN