Basic Information
| Provider Information | |||||||||
| NPI: | 1447318274 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLUME | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 8TH AVE W STE 101 | ||||||||
| Address2: | |||||||||
| City: | PALMETTO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342214737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417764000 | ||||||||
| FaxNumber: | 9418454963 | ||||||||
| Practice Location | |||||||||
| Address1: | 220 N TUTTLE AVE | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342375229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9413660800 | ||||||||
| FaxNumber: | 9413661102 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2006 | ||||||||
| LastUpdateDate: | 04/03/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD00025519 | WA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | ME115126 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 14PM2 | 01 | FL | BCBS | OTHER | 366524 | 01 | WA | LABOR & INDUSTRIES | OTHER | 1033606 | 05 | WA | MEDICAID | 008419600 | 05 | FL | MEDICAID | 8109357 | 05 | WA | MEDICAID |