Healthcare Provider Details

I. General information

NPI: 1730177098
Provider Name (Legal Business Name): PIERRE R BLEMUR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

486 FISHERMAN ST
OPA LOCKA FL
33054-3818
US

IV. Provider business mailing address

486 FISHERMAN ST
OPA LOCKA FL
33054-3818
US

V. Phone/Fax

Practice location:
  • Phone: 306-688-5456
  • Fax: 305-688-1661
Mailing address:
  • Phone: 305-688-5456
  • Fax: 305-688-1661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME0045180
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: