Provider Demographics
NPI:1821002627
Name:BLAND, STEPHEN LEON (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:LEON
Last Name:BLAND
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 1:1127 WILSHIRE BOULEVARD
Mailing Address - Street 2:STE 1010
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-4001
Mailing Address - Country:US
Mailing Address - Phone:213-977-0208
Mailing Address - Fax:213-977-0963
Practice Address - Street 1:1127 WILSHIRE BOULEVARD
Practice Address - Street 2:STE 1010
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4001
Practice Address - Country:US
Practice Address - Phone:213-977-0208
Practice Address - Fax:213-977-0963
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG5590207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000G55900Medicaid
G5590Medicare ID - Type Unspecified
A57316Medicare UPIN