Organization
BLAKE PAIN SOLUTIONS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACOB LEROY BLAKE MD (CEO/PHYSICIAN)
(503) 894-0365
Entity
Organization
Contact information
Practice address
2312 NE 129TH ST, VANCOUVER, WA 98686-3236
(360) 696-5022
(360) 696-5445
Mailing address
PO BOX 1600, VANCOUVER, WA 98668-1600
(360) 696-5022
(360) 696-5445
Taxonomy
Speciality
Code
Description
License number
State
261QP3300X
Pain Clinic/Center
Primary
MD60071790
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8537383
—
WA
Enumeration date
01/26/2012
Last updated
03/19/2012
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