Individual
DOUGLAS P BLACKALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4805 NE GLISAN ST, PORTLAND, OR 97213-2933
(503) 215-6096
Mailing address
PO BOX 3395, PORTLAND, OR 97208-3395
(503) 215-6023
Taxonomy
Speciality
Code
Description
License number
State
207ZB0001X
Blood Banking & Transfusion Medicine Physician
C-7459
AR
207ZB0001X
Blood Banking & Transfusion Medicine Physician
MD202871
OR
207ZC0006X
Clinical Pathology Physician
Primary
MD202871
OR
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
C-7459
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
152157001
—
AR
Enumeration date
10/13/2006
Last updated
01/15/2021
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