Individual
SALLY S BLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
7060 WAYSIDE DR, MENTOR, OH 44060-6527
(440) 357-2770
Mailing address
7060 WAYSIDE DR, MENTOR, OH 44060-6527
(440) 357-2770
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
C0005860
MD
363A00000X
Physician Assistant
MA051937
PA
363AM0700X
Medical Physician Assistant
Primary
50.004712RX
OH
Other
Enumeration date
06/12/2006
Last updated
08/17/2016
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