Basic Information
| Provider Information | |||||||||
| NPI: | 1912946831 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLUMENTHAL | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | LAWRENCE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 262409 | ||||||||
| Address2: | |||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750262409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9726085000 | ||||||||
| FaxNumber: | 9726085020 | ||||||||
| Practice Location | |||||||||
| Address1: | 6020 W PARKER RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750938171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9726085000 | ||||||||
| FaxNumber: | 9726085020 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 05/20/2008 | ||||||||
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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 | 207XS0117X | G2908 | TX | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine |
ID Information
| ID | Type | State | Issuer | Description | 1313496-04 | 05 | TX | MEDICAID |