Provider Demographics
NPI:1467408542
Name:BLADER, JOSEPH C (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:C
Last Name:BLADER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7703 FLOYD CURL DR
Mailing Address - Street 2:UT MEDICINE - PSYCHIATRY / CHILD & ADOLESCENT
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3901
Mailing Address - Country:US
Mailing Address - Phone:210-567-5312
Mailing Address - Fax:210-247-2264
Practice Address - Street 1:7703 FLOYD CURL DR
Practice Address - Street 2:UT MEDICINE - PSYCHIATRY / CHILD & ADOLESCENT
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3901
Practice Address - Country:US
Practice Address - Phone:210-567-5312
Practice Address - Fax:210-247-2264
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009654103T00000X
TX36694103TC2200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX330704301Medicaid
TX330704301Medicaid