Individual
DR. JONATHAN WILLIAM BLEVINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
39000 BOB HOPE DR DEPT OF, RANCHO MIRAGE, CA 92270-3221
(949) 263-8620
(800) 409-7005
Mailing address
PO BOX 18977, RENO, NV 89511-0550
(949) 263-8620
(800) 409-7005
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
A117764
CA
2085R0202X
Diagnostic Radiology Physician
MT189054
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A1177640
BC/BS OF CA
CA
05
—
1477710127
—
CA
Enumeration date
05/20/2008
Last updated
07/09/2017
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