Healthcare Provider Details

I. General information

NPI: 1497929236
Provider Name (Legal Business Name): DAVID B BLOMSTROM JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 12/24/2024
Certification Date: 12/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6715 BEAUFORD DR
AUSTIN TX
78750-8122
US

IV. Provider business mailing address

6715 BEAUFORD DR
AUSTIN TX
78750-8122
US

V. Phone/Fax

Practice location:
  • Phone: 512-954-0111
  • Fax:
Mailing address:
  • Phone: 512-954-0111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberP1051
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberP1051
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberP1051
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: