Provider Demographics
NPI:1720168156
Name:BLUMENREICH, BERNICE (MD)
Entity type:Individual
Prefix:
First Name:BERNICE
Middle Name:
Last Name:BLUMENREICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6630 DE MOSS DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-5004
Mailing Address - Country:US
Mailing Address - Phone:713-272-2600
Mailing Address - Fax:713-272-5589
Practice Address - Street 1:6630 DE MOSS DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-5004
Practice Address - Country:US
Practice Address - Phone:713-272-2600
Practice Address - Fax:713-272-5589
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF5472207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139114615Medicaid
TX139114611Medicaid
TX8B6443Medicaid
TX8B6443Medicaid
TX139114615Medicaid