Healthcare Provider Details

I. General information

NPI: 1982931275
Provider Name (Legal Business Name): DAVID H. BLATT, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2009
Last Update Date: 11/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 NW ELKS DR SUITE 202
CORVALLIS OR
97330-3885
US

IV. Provider business mailing address

350 NW ELKS DR SUITE 202
CORVALLIS OR
97330-3885
US

V. Phone/Fax

Practice location:
  • Phone: 541-758-8464
  • Fax: 541-758-8460
Mailing address:
  • Phone: 541-758-8464
  • Fax: 541-758-8460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberMD16833
License Number StateOR

VIII. Authorized Official

Name: DR. DAVID HOWARD BLATT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 541-758-8464