Provider Demographics
NPI:1982044640
Name:BLUTH, DOUGLAS M (DPM)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:M
Last Name:BLUTH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-4926
Mailing Address - Country:US
Mailing Address - Phone:559-584-5196
Mailing Address - Fax:559-584-9807
Practice Address - Street 1:806 W 7TH ST
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230
Practice Address - Country:US
Practice Address - Phone:559-584-5196
Practice Address - Fax:559-584-9807
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-26
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT37-2013390200000X
CAE5254213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program