Healthcare Provider Details

I. General information

NPI: 1811966898
Provider Name (Legal Business Name): DONOVAN C BLAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5196 HILL RD E STE 300
LAKEPORT CA
95453-6374
US

IV. Provider business mailing address

5196 HILL RD E STE 300
LAKEPORT CA
95453-6374
US

V. Phone/Fax

Practice location:
  • Phone: 707-263-6885
  • Fax: 707-263-6624
Mailing address:
  • Phone: 707-263-6885
  • Fax: 707-263-6624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberC151877
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: