Individual
DR. MITCHELL EDWARD BLUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2160 W. GRANTLINE RD, SUITE 250, TRACY, CA 95377
(209) 834-0626
(209) 834-1814
Mailing address
15 OVAL RD, OAKLAND, CA 94611
(209) 834-0626
(510) 817-4235
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
G25010
CA
207YS0123X
Facial Plastic Surgery Physician
G25010
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G250100
—
CA
Enumeration date
05/24/2005
Last updated
04/30/2015
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