Mendo Lake Urologic Medical Group, INC

NPI #1083646525 in Ukiah, California

Provider Information

NPI Number: 1083646525
Entity Type: Organization
Organization Name: Mendo Lake Urologic Medical Group, INC
Primary Specialty: Specialist
Enumeration Date: Jul 7, 2006
Last Updated: Jul 18, 2007

Practice Location

Address: 246 HOSPITAL DR
City: Ukiah
State: California
ZIP Code: 95482-4533
Phone: (707) 462-1928

Authorized Official

Name: DR. ROBERT EARL BLACKWELDER, MD
Title: OWNER
Phone: (707) 462-1928

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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