Provider Demographics
NPI:1356545412
Name:JEAN A. BLUESTEIN, M.D., P.A.
Entity type:Organization
Organization Name:JEAN A. BLUESTEIN, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLUESTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-615-6600
Mailing Address - Street 1:7950 FLOYD CURL DR
Mailing Address - Street 2:SUITE 1009
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3919
Mailing Address - Country:US
Mailing Address - Phone:210-615-6600
Mailing Address - Fax:210-615-7676
Practice Address - Street 1:7950 FLOYD CURL DR
Practice Address - Street 2:SUITE 1009
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3919
Practice Address - Country:US
Practice Address - Phone:210-615-6600
Practice Address - Fax:210-615-7676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8009207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U41VMedicare ID - Type Unspecified
TXTXB120099Medicare PIN
TXE51559Medicare UPIN