Healthcare Provider Details

I. General information

NPI: 1992745327
Provider Name (Legal Business Name): KENNETH SHERMAN BLOCHER D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 08/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4821 N STONE AVE
TUCSON AZ
85704-5727
US

IV. Provider business mailing address

12900 PARK PLAZA DR STE 150
CERRITOS CA
90703-9329
US

V. Phone/Fax

Practice location:
  • Phone: 480-200-3016
  • Fax:
Mailing address:
  • Phone: 629-774-6395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number0359
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: