Provider Demographics
NPI:1780688515
Name:BLOCK, STEVEN JAY (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:JAY
Last Name:BLOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 S HAM LN
Mailing Address - Street 2:STE G
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-3593
Mailing Address - Country:US
Mailing Address - Phone:209-334-3278
Mailing Address - Fax:209-334-1727
Practice Address - Street 1:777 S HAM LN
Practice Address - Street 2:STE G
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-3593
Practice Address - Country:US
Practice Address - Phone:209-334-3278
Practice Address - Fax:209-334-1727
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2009-05-05
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
CAG23058207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G230580OtherBLUE SHIELD
680095512OtherCHAMPUS
038331OtherHILL PHYSICIAN'S MED GP
CA00G230580OtherBLUE CROSS
001516OtherHEALTH NET
CA00G230580Medicaid
038331OtherHILL PHYSICIAN'S MED GP
001516OtherHEALTH NET
CA00G230580Medicare ID - Type Unspecified