Healthcare Provider Details

I. General information

NPI: 1962479089
Provider Name (Legal Business Name): THOMAS J BLUMENFELD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 04/22/2020
Certification Date: 04/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5725 W LAS POSITAS BLVD STE 200
PLEASANTON CA
94588-4007
US

IV. Provider business mailing address

5725 W LAS POSITAS BLVD STE 200
PLEASANTON CA
94588-4007
US

V. Phone/Fax

Practice location:
  • Phone: 925-272-2860
  • Fax:
Mailing address:
  • Phone: 925-272-2860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberG075858
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG75858
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: