Provider Demographics
NPI:1235458621
Name:STEPHEN L BLAND MD MEDICAL CORP
Entity Type:Organization
Organization Name:STEPHEN L BLAND MD MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:BLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-977-0208
Mailing Address - Street 1:1127 WILSHIRE BOULEVARD
Mailing Address - Street 2:SUITE 1010
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-4001
Mailing Address - Country:US
Mailing Address - Phone:213-977-0208
Mailing Address - Fax:213-977-0963
Practice Address - Street 1:1127 WILSHIRE BOULEVARD
Practice Address - Street 2:SUITE 1010
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4001
Practice Address - Country:US
Practice Address - Phone:213-977-0208
Practice Address - Fax:213-977-0963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG5590207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000G55900Medicaid
CAA57316Medicare UPIN
CAG5590Medicare PIN