Provider Demographics
NPI:1275752487
Name:WILLIAM J. BLAHA, M.D., INC.
Entity Type:Organization
Organization Name:WILLIAM J. BLAHA, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BLAHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-272-2858
Mailing Address - Street 1:152 CATHERINE LN
Mailing Address - Street 2:SUITE F
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5756
Mailing Address - Country:US
Mailing Address - Phone:530-272-2858
Mailing Address - Fax:530-272-1832
Practice Address - Street 1:152 CATHERINE LN
Practice Address - Street 2:SUITE F
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5756
Practice Address - Country:US
Practice Address - Phone:530-272-2858
Practice Address - Fax:530-272-1832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG495782084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA51406Medicare UPIN