Provider Demographics
NPI:1972803534
Name:JEFFREY P. BLOCK M. D., APC
Entity type:Organization
Organization Name:JEFFREY P. BLOCK M. D., APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:P
Authorized Official - Last Name:BLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-496-6613
Mailing Address - Street 1:2220 LYNN RD
Mailing Address - Street 2:302
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-1904
Mailing Address - Country:US
Mailing Address - Phone:805-496-6613
Mailing Address - Fax:805-496-8385
Practice Address - Street 1:2220 LYNN RD
Practice Address - Street 2:302
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-1904
Practice Address - Country:US
Practice Address - Phone:805-496-6613
Practice Address - Fax:805-496-8385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG36760207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty