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Organization

MOUNTAIN WEST DERM CALIFORNIA PC

Active
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Organization

MOUNTAIN WEST DERM CALIFORNIA PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
BRET BLACKHART MD (MD)
(775) 560-8668
Entity
Organization

Contact information

Practice address
10870 BROCKWAY RD, TRUCKEE, CA 96161
(530) 550-0440
(530) 582-8853
Mailing address
10870 BROCKWAY RD, TRUCKEE, CA 96161-2054
(530) 550-0440
(530) 582-8853

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
CA

Other

Enumeration date
10/06/2017
Last updated
08/13/2018
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