Individual
DR. JONATHAN M. BLATT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6542 SE LAKE RD., SUITE 202, MILWAUKIE, OR 97222
(503) 654-5636
(503) 654-5638
Mailing address
6542 SE LAKE RD., SUITE 202, MILWAUKIE, OR 97222
(503) 654-5636
(503) 654-5638
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
MD16764
OR
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
MD16764
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009907
—
OR
01
—
050038330
RR MEDICARE
OR
05
—
8291734
—
WA
Enumeration date
02/14/2006
Last updated
11/24/2009
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