Healthcare Provider Details

I. General information

NPI: 1609824747
Provider Name (Legal Business Name): RONALD I BLUM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 06/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 FOUNDERS STREET
PATTEN ME
04765
US

IV. Provider business mailing address

PO BOX 385
PATTEN ME
04765-0385
US

V. Phone/Fax

Practice location:
  • Phone: 207-528-2067
  • Fax: 207-528-2257
Mailing address:
  • Phone: 207-528-2067
  • Fax: 207-528-2257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number008285
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: