MEDICARE: JOHN K BLUM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	E4213	TX

General Provider Information

NPI Number	:	1356469092
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN K BLUM

Provider Business Mailing Address
First Line	:	1618 W 18TH ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-1525
Country	:	US
Telephone Number	:	713-802-4357
Fax Number	:	713-802-2659

Provider Business Practice Location Address
First Line	:	1618 W 18TH ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77008-1525
Country	:	US
Telephone Number	:	713-802-4357
Fax Number	:	713-802-2659

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. JOHN KARL BLUM
Credential	:	D.O.
Telephone Number	:	713-802-4357

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	11/10/2008

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