Individual
DR. RUSSELL R BLAKELEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
606 N THIRD AVE, SUITE 203, SANDPOINT, ID 83864-1594
(208) 263-8505
(208) 263-2908
Mailing address
2003 KOOTENAI HEALTH WAY, COEUR D ALENE, ID 83814-6051
(208) 652-5250
(208) 625-5251
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
16299
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3859386
—
TN
Enumeration date
09/29/2005
Last updated
01/27/2016
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