Healthcare Provider Details

I. General information

NPI: 1497727150
Provider Name (Legal Business Name): BETH E BLUMENSTEIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETH E BASLAW

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 09/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51600 HUNTINGTON RD
LA PINE OR
97739-8887
US

IV. Provider business mailing address

PO BOX 3300
LA PINE OR
97739-3300
US

V. Phone/Fax

Practice location:
  • Phone: 541-536-3435
  • Fax: 541-536-8047
Mailing address:
  • Phone: 541-536-3435
  • Fax: 541-536-8047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD24032
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: