Provider Demographics
NPI:1609295658
Name:BLEVINS, KATHERINE SHERMAN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:SHERMAN
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:MD, PHD
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Mailing Address - Street 1:500 SUPERIOR AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3660
Mailing Address - Country:US
Mailing Address - Phone:949-764-5350
Mailing Address - Fax:949-764-8557
Practice Address - Street 1:500 SUPERIOR AVE STE 100
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3660
Practice Address - Country:US
Practice Address - Phone:949-764-5350
Practice Address - Fax:949-764-8557
Is Sole Proprietor?:No
Enumeration Date:2014-04-07
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA138064208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery