Provider Demographics
NPI:1316133218
Name:ROSAS BLUM, EDUARDO DANIEL (MD)
Entity type:Individual
Prefix:
First Name:EDUARDO
Middle Name:DANIEL
Last Name:ROSAS BLUM
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 1:10470 VISTA DEL SOL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-7928
Mailing Address - Country:US
Mailing Address - Phone:915-615-7005
Mailing Address - Fax:
Practice Address - Street 1:10470 VISTA DEL SOL DR STE 100
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-7928
Practice Address - Country:US
Practice Address - Phone:915-615-7005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD 2009-0066208000000X
TXN4046208000000X, 2080P0206X, 2080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics