NPIMap

Organization Active NPI

Mitchell E. Blum M.D., F.a.C.S., Inc.

  • Facial Plastic Surgery Physician
  • Tracy, CA
National Provider Identifier
1356717854
Registry record updated Sep 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Facial Plastic Surgery PhysicianTaxonomy code 207YS0123X
License
G25010 Issued in CA
Legal business name
MITCHELL E. BLUM M.D., F.A.C.S., INC.
Practice address
2160 W Grant Line Rd
Suite 250
Tracy, CA 95377-7330
Phone
(209) 834-0626
Fax
(209) 834-1814
NPI assigned
Aug 19, 2015
Last updated
Sep 23, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mitchell E. Blum, M.D.NPI 1770586448
Title
Ceo
Phone
(209) 834-0626

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Facial Plastic Surgery Physician 207YS0123X G25010 CA Primary

Addresses

Primary practice location

2160 W Grant Line Rd
Suite 250
Tracy, CA 95377-7330

Mailing address

2160 W Grant Line Rd
Suite 250
Tracy, CA 95377-7330
Phone (209) 834-0626

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1439942400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1442966400000",
    "number": "1356717854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2160 W GRANT LINE RD",
            "address_2": "SUITE 250",
            "city": "TRACY",
            "state": "CA",
            "postal_code": "953777330",
            "telephone_number": "209-834-0626",
            "fax_number": "209-834-1814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2160 W GRANT LINE RD",
            "address_2": "SUITE 250",
            "city": "TRACY",
            "state": "CA",
            "postal_code": "953777330",
            "telephone_number": "209-834-0626",
            "fax_number": "209-834-1814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MITCHELL E. BLUM M.D., F.A.C.S., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-19",
        "last_updated": "2015-09-23",
        "status": "A",
        "authorized_official_last_name": "BLUM",
        "authorized_official_first_name": "MITCHELL",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "209-834-0626",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207YS0123X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Facial Plastic Surgery",
            "state": "CA",
            "license": "G25010",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tracy, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.