Provider Demographics
NPI:1801859095
Name:BLAHA, WILLIAM JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:BLAHA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:152 CATHERINE LN
Mailing Address - Street 2:SUITE F
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5756
Mailing Address - Country:US
Mailing Address - Phone:530-272-2858
Mailing Address - Fax:530-272-1832
Practice Address - Street 1:152 CATHERINE LN
Practice Address - Street 2:SUITE F
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5756
Practice Address - Country:US
Practice Address - Phone:530-272-2858
Practice Address - Fax:530-272-1832
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-09
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG495782084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA51406Medicare UPIN