Individual
NICHOLAS ZOLTAN BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
76 NE 12TH ST, MADRAS, OR 97741-1827
(406) 258-4789
(406) 258-4732
Mailing address
2385 NE HILLTOP LN, MADRAS, OR 97741-8733
(406) 258-4789
(406) 258-4732
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD184258
OR
Other
Enumeration date
06/06/2014
Last updated
07/21/2022
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