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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