MEDICARE: WILLIAM J. BLAUMER

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	122300000X	Dentist	5206	OR
2	122300000X	Dentist	5090	OR
3	122300000X	Dentist	5026	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	91900	OTHER	OR	UNITED CONCORDIA
2	54495	OTHER	OR	UNITED CONCORDIA

General Provider Information

NPI Number	:	1750526893
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM J. BLAUMER

Provider Business Mailing Address
First Line	:	1355 EDGEWATER ST NW
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97304-4077
Country	:	US
Telephone Number	:	503-588-6960
Fax Number	:	503-365-0056

Provider Business Practice Location Address
First Line	:	1355 EDGEWATER ST NW
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97304-4077
Country	:	US
Telephone Number	:	503-588-6960
Fax Number	:	503-365-0056

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. DEANA JEANINE BALLARD
Credential	:
Telephone Number	:	503-588-6960

Provider Enumeration Date	:	12/03/2008
Last Update Date	:	12/03/2008

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Directions to “WILLIAM J. BLAUMER ” Practice Location

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