Provider Demographics
NPI:1356437115
Name:BLOLAND, ERIC CRAIG (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:CRAIG
Last Name:BLOLAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 NORTH CENTER ST #800
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-7406
Mailing Address - Country:US
Mailing Address - Phone:801-990-1911
Mailing Address - Fax:801-990-1912
Practice Address - Street 1:8TH AVENUE AND C STREET
Practice Address - Street 2:LDS HOSPITAL
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84143
Practice Address - Country:US
Practice Address - Phone:801-507-5248
Practice Address - Fax:801-733-5618
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT84-172104-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002087148Medicaid
AZ127937Medicaid
WY109358400Medicaid
UT37775OtherPEHP
UT1502954OtherUMWA
UT53227OtherHEALTHY U
UTQM0000075886OtherALTIUS
UT107005527101OtherIHC
UT2090168OtherUNITED HEALTHCARE
UT8597445OtherWORKERS COMP
ID000477100Medicaid
UTPRA04664OtherMOLINA
UT17499OtherDESERET MUTUAL
UT870545614BL1OtherEDUCATORS MUTUAL
UT53227OtherHEALTHY U
WY109358400Medicaid
ID000477100Medicaid