Individual
BLAKE MCCONNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2485 12TH ST SE, SALEM, OR 97302-2151
(503) 363-8047
(503) 363-6571
Mailing address
PO BOX 13129, SALEM, OR 97309-1129
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
12439658-1205
UT
207Q00000X
Family Medicine Physician
Primary
MD215853
OR
Other
Enumeration date
07/02/2019
Last updated
09/06/2023
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