Healthcare Provider Details

I. General information

NPI: 1730373010
Provider Name (Legal Business Name): KEITH S BLUM DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 02/14/2020
Certification Date: 02/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7271 W SAHARA AVE STE 100
LAS VEGAS NV
89117-2862
US

IV. Provider business mailing address

7271 W SAHARA AVE STE 100
LAS VEGAS NV
89117-2862
US

V. Phone/Fax

Practice location:
  • Phone: 702-240-4090
  • Fax: 702-240-4091
Mailing address:
  • Phone: 702-240-4090
  • Fax: 702-240-4091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: KEITH S BLUM
Title or Position: PRESIDENT
Credential: D.O.
Phone: 702-240-4091