Healthcare Provider Details

I. General information

NPI: 1780074831
Provider Name (Legal Business Name): DAVID C. BLUMER, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2015
Last Update Date: 01/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 SW 2ND AVE SUITE 204
GAINESVILLE FL
32601-6271
US

IV. Provider business mailing address

720 SW 2ND AVE SUITE 204
GAINESVILLE FL
32601-6271
US

V. Phone/Fax

Practice location:
  • Phone: 352-372-1878
  • Fax: 352-372-7562
Mailing address:
  • Phone: 352-372-1878
  • Fax: 352-372-7562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number30193
License Number StateFL

VIII. Authorized Official

Name: DR. DAVID C BLUMER
Title or Position: SOLE PROPRIETOR
Credential: M.D.
Phone: 352-372-1878