Provider Demographics
NPI:1710192943
Name:BLAIR C. FILLER, M.D., INC.
Entity Type:Organization
Organization Name:BLAIR C. FILLER, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAIR
Authorized Official - Middle Name:C
Authorized Official - Last Name:FILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-742-1545
Mailing Address - Street 1:2400 S FLOWER ST FL 3
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007-2629
Mailing Address - Country:US
Mailing Address - Phone:213-742-1545
Mailing Address - Fax:213-742-1583
Practice Address - Street 1:2400 S FLOWER ST FL 3
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-2629
Practice Address - Country:US
Practice Address - Phone:213-742-1545
Practice Address - Fax:213-742-1583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC19000207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA86548Medicare UPIN