Individual
BLAKE BLOOMQUIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
503 AIRPORT RD STE 101, MEDFORD, OR 97504-4159
(541) 200-2900
(541) 200-2948
Mailing address
3587 HEATHROW WAY, MEDFORD, OR 97504-4004
(541) 858-8170
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
05/16/2014
Last updated
10/14/2021
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