Individual
DR. JACOB L BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5590 KIETZKE LN, RENO, NV 89511-3019
(775) 323-2080
(775) 683-9404
Mailing address
5590 KIETZKE LN, RENO, NV 89511-3019
(775) 323-2080
(775) 323-8216
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
14407
NV
207L00000X
Anesthesiology Physician
A95206
CA
207L00000X
Anesthesiology Physician
MD60071790
WA
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
14407
NV
207LP2900X
Pain Medicine (Anesthesiology) Physician
A95206
CA
207LP2900X
Pain Medicine (Anesthesiology) Physician
MD60071790
WA
Other
Enumeration date
12/26/2006
Last updated
01/29/2019
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