Individual
ALICE P BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
222 N 2ND ST STE 304, BOISE, ID 83702-6131
(208) 342-7722
Mailing address
222 N 2ND ST STE 304, BOISE, ID 83702-6131
(208) 342-7722
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
M5730
ID
208000000X
Pediatrics Physician
M-5730
ID
Other
Enumeration date
06/06/2006
Last updated
06/10/2021
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