Individual
JEFFREY CLARK BLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3030 LATROBE DR, CHARLOTTE, NC 28211-4866
(704) 362-1945
(704) 770-0501
Mailing address
3816 LATROBE DR, CHARLOTTE, NC 28211-1167
(704) 362-1945
(704) 770-0501
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
21452
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8916383
—
NC
Enumeration date
04/11/2006
Last updated
07/28/2010
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