MEDICARE: DR. PHILLIP STEPHEN BLAND 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	207RS0010X	Sports Medicine (Internal Medicine) Physician	G62795	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881776524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILLIP STEPHEN BLAND MD

Provider Business Mailing Address
First Line	:	1127 WILSHIRE BLVD
Second Line	:	SUITE 1010
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-4001
Country	:	US
Telephone Number	:	213-977-1047
Fax Number	:	213-977-9160

Provider Business Practice Location Address
First Line	:	1127 WILSHIRE BLVD
Second Line	:	SUITE 1010
City	:	LOS ANGELES
State	:	CA
Zip	:	90017-4001
Country	:	US
Telephone Number	:	213-977-1047
Fax Number	:	213-977-9160

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

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	04/02/2014

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