Individual
DR. BENNETT BLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5425 E BROADWAY BLVD, PMB #358, TUCSON, AZ 85711-3704
(520) 990-4145
Mailing address
5425 E BROADWAY BLVD, PMB #358, TUCSON, AZ 85711-3704
(520) 990-4145
Taxonomy
Speciality
Code
Description
License number
State
2084F0202X
Forensic Psychiatry Physician
27112
AZ
2084F0202X
Forensic Psychiatry Physician
G72139
CA
2084P0800X
Psychiatry Physician
G72139
CA
2084P0805X
Geriatric Psychiatry Physician
Primary
27112
AZ
2084P0805X
Geriatric Psychiatry Physician
G72139
CA
208D00000X
General Practice Physician
27112
AZ
208D00000X
General Practice Physician
G72139
CA
Other
Enumeration date
01/05/2011
Last updated
01/05/2011
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