Individual
MR. BLAINE B. ROURKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1046 6TH AVE SW, ALBANY, OR 97321-1916
(541) 812-4000
Mailing address
PO BOX 1189, CORVALLIS, OR 97339-1189
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
DO217686
OR
363A00000X
Physician Assistant
PA03254
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
182196901
—
TX
01
—
8L5723
MEDICARE PTAN
TX
Enumeration date
07/15/2006
Last updated
04/08/2025
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