Provider Demographics
NPI:1508026097
Name:NIGUSSE BLAND, ANTON (MD)
Entity Type:Individual
Prefix:
First Name:ANTON
Middle Name:
Last Name:NIGUSSE BLAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DEMEDRICK
Other - Middle Name:ANTON
Other - Last Name:BLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1001 POTRERO AVE
Mailing Address - Street 2:UCSF BOX 0852-7M8
Mailing Address - City:SAN FRANCSICO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-3518
Mailing Address - Country:US
Mailing Address - Phone:628-206-8426
Mailing Address - Fax:628-206-8942
Practice Address - Street 1:1001 POTRERO AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3518
Practice Address - Country:US
Practice Address - Phone:628-206-8426
Practice Address - Fax:628-206-8942
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-10
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1254832084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry