Individual
JACOB WILEY BLICKENSTAFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1329 LUSITANA ST STE 604, HONOLULU, HI 96813-2431
(808) 531-1116
Mailing address
1329 LUSITANA ST STE 604, HONOLULU, HI 96813-2431
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MD-20256
HI
Other
Enumeration date
07/12/2015
Last updated
01/31/2022
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