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General NPI Number Information
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NPI Number | 1114362175
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Entity Type | Individual
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Provider Name | CHARLES PHILIP BLACKSHEAR M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/05/2013
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Last Update Date | 03/28/2019
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Provider Practice Location Address
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Address Line | 4949 STEVENS CREEK BLVD
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City | SANTA CLARA
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State | CA
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Zip | 95051-6661
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Country | US
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Telephone | 408-260-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 1389 JEFFERSON ST UNIT A507
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City | OAKLAND
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State | CA
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Zip | 94612-1670
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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