Provider Demographics
NPI:1104965326
Name:BLUM, ROBERT S (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:BLUM
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1416 TENNESSEE ST
Mailing Address - Street 2:STE 6
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-4647
Mailing Address - Country:US
Mailing Address - Phone:707-552-6633
Mailing Address - Fax:707-552-0702
Practice Address - Street 1:1416 TENNESSEE ST
Practice Address - Street 2:STE 6
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-4647
Practice Address - Country:US
Practice Address - Phone:707-552-6633
Practice Address - Fax:707-552-0702
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CAG96142084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology