Provider Demographics
NPI:1881776524
Name:BLAND, PHILLIP STEPHEN (MD)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:STEPHEN
Last Name:BLAND
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1127 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 1010
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-4001
Mailing Address - Country:US
Mailing Address - Phone:213-977-1047
Mailing Address - Fax:213-977-9160
Practice Address - Street 1:1127 WILSHIRE BLVD
Practice Address - Street 2:SUITE 1010
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4001
Practice Address - Country:US
Practice Address - Phone:213-977-1047
Practice Address - Fax:213-977-9160
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2014-04-02
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Provider Licenses
StateLicense IDTaxonomies
CAG62795207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G627950Medicaid
CA00G627950Medicaid
F53201Medicare UPIN