Healthcare Provider Details

I. General information

NPI: 1598767378
Provider Name (Legal Business Name): GREGORY FRANKLIN BLAND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 N UNION BLVD SUITE 300
COLORADO SPRINGS CO
80907-4900
US

IV. Provider business mailing address

3920 N UNION BLVD SUITE 300
COLORADO SPRINGS CO
80907-4900
US

V. Phone/Fax

Practice location:
  • Phone: 719-634-0107
  • Fax: 719-634-5832
Mailing address:
  • Phone: 719-634-0107
  • Fax: 719-634-5832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number33406
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: