Provider Demographics
NPI:1962698167
Name:ERIC R. CARLBLOM, MD.,PC
Entity type:Organization
Organization Name:ERIC R. CARLBLOM, MD.,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:ROLF
Authorized Official - Last Name:CARLBLOM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-462-1500
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-0339
Mailing Address - Country:US
Mailing Address - Phone:831-462-1500
Mailing Address - Fax:831-462-1503
Practice Address - Street 1:2425 PORTER ST
Practice Address - Street 2:SUITE 6
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2444
Practice Address - Country:US
Practice Address - Phone:831-462-1500
Practice Address - Fax:831-462-1503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG65524207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G655240Medicaid
CA1962698167Medicaid
CA00G655240Medicaid
CAZZZ06891ZMedicare PIN