Provider Demographics
NPI:1215987086
Name:BLASE, WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:BLASE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2390 E FLORIDA AVE
Mailing Address - Street 2:207
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92544-4707
Mailing Address - Country:US
Mailing Address - Phone:951-652-6100
Mailing Address - Fax:951-658-7548
Practice Address - Street 1:2390 E FLORIDA AVE
Practice Address - Street 2:#207
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-4707
Practice Address - Country:US
Practice Address - Phone:951-652-6100
Practice Address - Fax:951-658-7548
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG50680174400000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA51771Medicare UPIN