Individual
JEFFREY L BLICKENSTAFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
665 3RD ST SW, PERHAM, MN 56573-1108
(218) 346-4040
(218) 346-4043
Mailing address
665 3RD ST SW, PERHAM, MN 56573-1108
(218) 346-4040
(218) 346-4043
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
27074
MN
Other
Enumeration date
07/18/2006
Last updated
01/05/2012
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