Provider Demographics
NPI:1861498982
Name:BLUMOFF, RONALD L (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:L
Last Name:BLUMOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 PARK TEN BLVD
Mailing Address - Street 2:STE 154 E
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-4211
Mailing Address - Country:US
Mailing Address - Phone:210-828-2503
Mailing Address - Fax:210-828-0590
Practice Address - Street 1:6800 PARK TEN BLVD
Practice Address - Street 2:STE 154 E
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-4211
Practice Address - Country:US
Practice Address - Phone:210-828-2503
Practice Address - Fax:210-828-0590
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMDF77022086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81A603Medicare ID - Type Unspecified
TXC13562Medicare UPIN