MEDICARE: NOAH M BLUM D.P.M.

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	213E00000X	Podiatrist	P02942	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	65763	OTHER	FL	BC/BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528075041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOAH M BLUM D.P.M.

Provider Business Mailing Address
First Line	:	2316 NEBRASKA AVE
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4824
Country	:	US
Telephone Number	:	772-489-4343
Fax Number	:	772-489-4543

Provider Business Practice Location Address
First Line	:	2316 NEBRASKA AVE
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4824
Country	:	US
Telephone Number	:	772-489-4343
Fax Number	:	772-489-4543

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	01/09/2013

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