Individual
BRUCE ALAN BLACKHART
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1425 W H ST, STE 200, OAKDALE, CA 95361-3588
(209) 848-1005
(209) 845-8918
Mailing address
1425 W H ST, STE 200, OAKDALE, CA 95361-3588
(209) 848-1005
(209) 845-8918
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
G65918
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G659180
—
CA
Enumeration date
10/10/2005
Last updated
02/04/2015
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