MEDICARE: DR. SCOTT L. BLEAZARD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	C55792	CA
2	2085R0202X	Diagnostic Radiology Physician	MD22503	OR

General Provider Information

NPI Number	:	1679695761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT L. BLEAZARD MD

Provider Business Mailing Address
First Line	:	PO BOX 1086
Second Line	:
City	:	YREKA
State	:	CA
Zip	:	96097-1086
Country	:	US
Telephone Number	:	530-842-7297
Fax Number	:	530-842-9054

Provider Business Practice Location Address
First Line	:	914 PINE ST
Second Line	:
City	:	MT SHASTA
State	:	CA
Zip	:	96067
Country	:	US
Telephone Number	:	530-926-9329
Fax Number	:	855-251-4626

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2007
Last Update Date	:	03/24/2026

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