Provider Demographics
NPI:1801993878
Name:BLUMENAU, JOE (MD, FAAFP)
Entity type:Individual
Prefix:DR
First Name:JOE
Middle Name:
Last Name:BLUMENAU
Suffix:
Gender:M
Credentials:MD, FAAFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5715 STILL FOREST DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-4916
Mailing Address - Country:US
Mailing Address - Phone:972-931-2586
Mailing Address - Fax:972-931-2586
Practice Address - Street 1:5715 STILL FOREST DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-4916
Practice Address - Country:US
Practice Address - Phone:972-931-2586
Practice Address - Fax:972-931-2586
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF.0135207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXLH63Medicare UPIN