Individual
JUSTIN BLATY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1075 N CURTIS RD STE 201, BOISE, ID 83706-1350
(208) 302-3300
(208) 302-3355
Mailing address
PO BOX 190930, BOISE, ID 83719-0930
(208) 367-5170
(208) 367-5180
Taxonomy
Speciality
Code
Description
License number
State
2080S0012X
Pediatric Sleep Medicine Physician
77233
WI
2080S0012X
Pediatric Sleep Medicine Physician
Primary
M-17623
ID
2080S0012X
Pediatric Sleep Medicine Physician
MD61145727
WA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1548766835
—
WI
Enumeration date
04/04/2018
Last updated
05/19/2024
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