Healthcare Provider Details

I. General information

NPI: 1609008614
Provider Name (Legal Business Name): BLAKE A. STRAGIER R.C.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2009
Last Update Date: 08/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S WOODRUFF AVE SUITE 12 B
IDAHO FALLS ID
83404-6374
US

IV. Provider business mailing address

2001 S WOODRUFF AVE SUITE 12 B
IDAHO FALLS ID
83404-6374
US

V. Phone/Fax

Practice location:
  • Phone: 208-529-2498
  • Fax: 208-528-7971
Mailing address:
  • Phone: 208-529-2498
  • Fax: 208-528-7971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246W00000X
TaxonomyCardiology Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: