Individual
BLAKE DAVID LOLLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., MPH
Contact information
Practice address
302 S 10TH AVE, YAKIMA, WA 98901
(509) 574-3380
Mailing address
302 S 10TH AVE, YAKIMA, WA 98902-3521
(509) 574-3380
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD60584660
WA
2083X0100X
Occupational Medicine Physician
MD60584660
WA
Other
Enumeration date
09/07/2005
Last updated
09/07/2016
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