Individual
RICHARD W BLAINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
737 BROADWAY N, FARGO, ND 58122-0001
(701) 234-4811
(701) 234-6979
Mailing address
2400 32ND AVE S, FARGO, ND 58103-5800
(701) 234-8860
(701) 234-8924
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
3003
ND
Other
Enumeration date
07/16/2006
Last updated
07/08/2007
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