Individual
BLAKE AUSTIN MANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
747 BROADWAY, SEATTLE, WA 98122-4379
(206) 215-2520
(206) 215-6364
Mailing address
PO BOX 25608, SALT LAKE CITY, UT 84125-0608
(206) 320-4476
(206) 568-7043
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD60268728
WA
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
MD60268728
WA
207RP1001X
Pulmonary Disease Physician
Primary
MD60268728
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1629210059
—
WA
Enumeration date
03/31/2009
Last updated
06/17/2021
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