Provider Demographics
NPI:1598767550
Name:BLOCK, PAUL RONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:RONALD
Last Name:BLOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:227 W JANSS RD
Mailing Address - Street 2:STE 305
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-1848
Mailing Address - Country:US
Mailing Address - Phone:805-449-4181
Mailing Address - Fax:805-494-9152
Practice Address - Street 1:227 W JANSS RD
Practice Address - Street 2:STE 305
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-1848
Practice Address - Country:US
Practice Address - Phone:805-449-4181
Practice Address - Fax:805-494-9152
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-02
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC33046207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C330460Medicare ID - Type Unspecified
CAA35143Medicare UPIN