Organization
MITCHELL E. BLUM M.D., F.A.C.S., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MITCHELL E. BLUM M.D. (CEO)
(209) 834-0626
Entity
Organization
Contact information
Practice address
2160 W GRANT LINE RD, SUITE 250, TRACY, CA 95377-7330
(209) 834-0626
(209) 834-1814
Mailing address
2160 W GRANT LINE RD, SUITE 250, TRACY, CA 95377-7330
(209) 834-0626
(209) 834-1814
Taxonomy
Speciality
Code
Description
License number
State
207YS0123X
Facial Plastic Surgery Physician
Primary
G25010
CA
Other
Enumeration date
08/19/2015
Last updated
09/23/2015
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