Healthcare Provider Details

I. General information

NPI: 1265653059
Provider Name (Legal Business Name): BENNETT BLUM, MD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150 E BROADWAY BLVD #1600
TUCSON AZ
85711-3762
US

IV. Provider business mailing address

5425 E BROADWAY BLVD PMB #358
TUCSON AZ
85711-3704
US

V. Phone/Fax

Practice location:
  • Phone: 520-750-8868
  • Fax:
Mailing address:
  • Phone: 520-750-8868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number27112
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number27112
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code2084H0002X
TaxonomyHospice and Palliative Medicine (Psychiatry & Neurology) Physician
License Number27112
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number27112
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number27112
License Number StateAZ
# 6
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number27112
License Number StateAZ
# 7
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number27112
License Number StateAZ
# 8
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number27112
License Number StateAZ
# 9
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number27112
License Number StateAZ
# 10
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number27112
License Number StateAZ
# 11
Primary TaxonomyN
Taxonomy Code209800000X
TaxonomyLegal Medicine (M.D./D.O.) Physician
License Number27112
License Number StateAZ
# 12
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberG72139
License Number StateCA

VIII. Authorized Official

Name: DR. BENNETT BLUM
Title or Position: PRESIDENT
Credential: M.D.
Phone: 520-750-8868