Healthcare Provider Details

I. General information

NPI: 1982925368
Provider Name (Legal Business Name): BLAIR R. L. COLWELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2010
Last Update Date: 05/29/2020
Certification Date: 05/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 STOCKTON BLVD DEPT. OF PEDIATRICS, UCDMC
SACRAMENTO CA
95817-2201
US

IV. Provider business mailing address

2315 STOCKTON BLVD DEPT. OF PEDIATRICS, UCDMC
SACRAMENTO CA
95817-2201
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-3665
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberA118397
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: