Individual
DR. BERNARD IRVING BLUMENTHAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-2538
(601) 815-1854
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-2538
(601) 815-1854
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
05088
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00019632
—
MS
01
—
300071324
RAILROAD MEDICARE
MS
01
—
512G700003
MS MEDICARE - GROUP
MS
Enumeration date
06/30/2006
Last updated
06/15/2012
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