Healthcare Provider Details

I. General information

NPI: 1902885155
Provider Name (Legal Business Name): DONALD R BLUM D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 FOREST LN C-435
DALLAS TX
75230-2505
US

IV. Provider business mailing address

7777 FOREST LN SUITE C-435
DALLAS TX
75230-2505
US

V. Phone/Fax

Practice location:
  • Phone: 972-566-3808
  • Fax: 972-566-4690
Mailing address:
  • Phone: 972-566-3808
  • Fax: 972-566-4690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0666
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0666
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number0666
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License Number0666
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: