Individual
BLAKE ALEXANDER EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
400 HICKORY ST NW, ALBANY, OR 97321-1700
(541) 812-5840
Mailing address
PO BOX 1188, CORVALLIS, OR 97339-1188
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
64405
OR
Other
Enumeration date
06/23/2022
Last updated
08/22/2022
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