Blakeley, Russell R

Blakeley, Russell R is an individual health care provider with primary practice located at 606 N Third Ave Suite 203, Sandpoint ID 83864-1594. He recently has only one registered license in Allopathic & Osteopathic Physicians / Cardiovascular Disease, which is considered as his primary health care specialty. Blakeley, Russell R can be contacted via phone (208) 263-8505.

Contact Information

Primary practice address
606 N Third Ave Suite 203 Sandpoint ID 83864-1594
Phone: (208) 263-8505
Fax: (208) 263-2908
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Cardiovascular Disease 207RC0000X 16299 Tennessee

Profile Details

NPI number 1063409639
LBN Legal business name Blakeley, Russell R
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 29th, 2005
Last updated Jan 27th, 2016 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1063409639 NPPES
Tennessee MEDICAID 3859386

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