Provider Demographics
NPI:1902885155
Name:BLUM, DONALD R (DPM)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:R
Last Name:BLUM
Suffix:
Gender:M
Credentials:DPM
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Other - First Name:
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Mailing Address - Street 1:7777 FOREST LN
Mailing Address - Street 2:SUITE C-435
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2505
Mailing Address - Country:US
Mailing Address - Phone:972-566-3808
Mailing Address - Fax:972-566-4690
Practice Address - Street 1:7777 FOREST LN
Practice Address - Street 2:C-435
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2505
Practice Address - Country:US
Practice Address - Phone:972-566-3808
Practice Address - Fax:972-566-4690
Is Sole Proprietor?:No
Enumeration Date:2006-01-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX0666213E00000X, 213ES0103X, 213ES0131X, 213ES0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXL0036465OtherDEPT PUBLIC SAFETY DPS
TX12153304Medicaid
TXAB8600668OtherDEA
TXAB8600668OtherDEA
TX8792J0Medicare ID - Type Unspecified
TX12153304Medicaid