Provider Demographics
NPI:1730373010
Name:KEITH S BLUM DO PC
Entity type:Organization
Organization Name:KEITH S BLUM DO PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:S
Authorized Official - Last Name:BLUM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-240-4091
Mailing Address - Street 1:7271 W SAHARA AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2862
Mailing Address - Country:US
Mailing Address - Phone:702-240-4090
Mailing Address - Fax:702-240-4091
Practice Address - Street 1:7271 W SAHARA AVE STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2862
Practice Address - Country:US
Practice Address - Phone:702-240-4090
Practice Address - Fax:702-240-4091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV38894Medicare PIN