Provider Demographics
NPI:1780074831
Name:DAVID C. BLUMER, MD
Entity type:Organization
Organization Name:DAVID C. BLUMER, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:BLUMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-372-1878
Mailing Address - Street 1:720 SW 2ND AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-6271
Mailing Address - Country:US
Mailing Address - Phone:352-372-1878
Mailing Address - Fax:352-372-7562
Practice Address - Street 1:720 SW 2ND AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-6271
Practice Address - Country:US
Practice Address - Phone:352-372-1878
Practice Address - Fax:352-372-7562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30193261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL207N00000XOtherTAXONOMY NUMBER