Provider Demographics
NPI:1760486310
Name:BLUME, MARTIN (DO MBA)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
Last Name:BLUME
Suffix:
Gender:M
Credentials:DO MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8575 E PRINCESS DR
Mailing Address - Street 2:SUITE 111
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-5483
Mailing Address - Country:US
Mailing Address - Phone:480-699-7999
Mailing Address - Fax:480-247-7580
Practice Address - Street 1:8575 E PRINCESS DR
Practice Address - Street 2:SUITE 111
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-5483
Practice Address - Country:US
Practice Address - Phone:480-699-7999
Practice Address - Fax:480-247-7580
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ1641207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ246745Medicaid
AZD47216Medicare UPIN
AZ70528Medicare ID - Type Unspecified