Active NPI
Kenneth Paul Goldblum, M.D.
- Ophthalmology Physician
- Albuquerque, NM
National Provider Identifier
1720085889
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- NM145
- Practice address
- 303 Mulberry NE
Albuquerque, NM 87106 - Phone
- (505) 243-9739
- Fax
- (505) 842-0650
- NPI assigned
- Jul 5, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | NM145 | NM | Primary |
| Ophthalmology Physician | 207W00000X | 71-145 | NM |
Addresses
Primary practice location
303 Mulberry NE
Albuquerque, NM 87106
Mailing address
303 Mulberry NE
Albuquerque, NM 87106
Phone (505) 243-9739
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 71-145 | NM | MD | Ophthalmology Physician |
| NM145 | NM | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1120521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1225843200000",
"number": "1720085889",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "303 MULBERRY NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "87106",
"telephone_number": "505-243-9739",
"fax_number": "505-842-0650"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "303 MULBERRY NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "87106",
"telephone_number": "505-243-9739",
"fax_number": "505-842-0650"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOLDBLUM",
"first_name": "KENNETH",
"middle_name": "PAUL",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-05",
"last_updated": "2008-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "NM",
"license": "NM145",
"primary": true
},
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "NM",
"license": "71-145",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.