Healthcare Provider Details

I. General information

NPI: 1508845736
Provider Name (Legal Business Name): JOEL SAUL BLUMBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 02/23/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4849 CALHOUN RD. HEALTH 2 BUILDING, SUITE #1001-A
HOUSTON TX
77204-6066
US

IV. Provider business mailing address

205 E UNIVERSITY AVE STE 200
GEORGETOWN TX
78626-6821
US

V. Phone/Fax

Practice location:
  • Phone: 877-800-5722
  • Fax: 713-481-1730
Mailing address:
  • Phone: 512-686-0207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberH7907
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number44261
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: