Provider Demographics
NPI:1134230410
Name:NANCY A BLUM DO PLC
Entity type:Organization
Organization Name:NANCY A BLUM DO PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLUM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:928-717-1600
Mailing Address - Street 1:3105 CLEARWATER DR STE A
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-7166
Mailing Address - Country:US
Mailing Address - Phone:928-717-1600
Mailing Address - Fax:
Practice Address - Street 1:3105 CLEARWATER DR STE A
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-7166
Practice Address - Country:US
Practice Address - Phone:928-717-1600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ101593Medicare ID - Type Unspecified