Provider Demographics
NPI:1467420802
Name:GOLDBLATT, WILLIAM GERALD (DPM)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:GERALD
Last Name:GOLDBLATT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 N SAN DIMAS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-2601
Mailing Address - Country:US
Mailing Address - Phone:909-592-4438
Mailing Address - Fax:909-592-4439
Practice Address - Street 1:322 N SAN DIMAS AVE
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-2601
Practice Address - Country:US
Practice Address - Phone:909-592-4438
Practice Address - Fax:909-592-4439
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2896213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E28960Medicaid
CA000E28960Medicaid
CAE2896Medicare PIN