Individual
JAMES L BLAINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C
Contact information
Practice address
1448 E CENTER ST STE E, POCATELLO, ID 83201-4132
(208) 234-1300
(208) 234-1333
Mailing address
1448 E CENTER ST STE E, POCATELLO, ID 83201-4132
(208) 234-1300
(208) 234-1333
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA-353
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1667204
MEDICARE PTAN
ID
05
—
1801963459
—
ID
Enumeration date
11/29/2006
Last updated
06/29/2022
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