Healthcare Provider Details

I. General information

NPI: 1144542028
Provider Name (Legal Business Name): DEBORAH T BLUMENTHAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2010
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 WEIZMAN ST
TEL AVIV ISRAEL
64239
IL

IV. Provider business mailing address

1811 BRYAN AVE
SALT LAKE CITY UT
84108-2607
US

V. Phone/Fax

Practice location:
  • Phone: 11-972-3697
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number#98-359532-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: