Individual
MR. BLAKE GIBSON WHITAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2005 SW LEEWOOD DR, ALOHA, OR 97003-2104
(503) 840-2038
Mailing address
2005 SW LEEWOOD DR, ALOHA, OR 97003-2104
(503) 840-2038
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
OR
Other
Enumeration date
06/25/2019
Last updated
06/25/2019
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