Healthcare Provider Details

I. General information

NPI: 1427053859
Provider Name (Legal Business Name): JOBST GEBHARD BLUM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6161 S YALE AVE
TULSA OK
74136-1902
US

IV. Provider business mailing address

6839 S CANTON AVE
TULSA OK
74136-3402
US

V. Phone/Fax

Practice location:
  • Phone: 918-494-1980
  • Fax:
Mailing address:
  • Phone: 918-494-0612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number13619
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: