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General NPI Number Information
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NPI Number | 1568449916
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Entity Type | Individual
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Provider Name | CHRISTOPHER KYNRINT BLAZES MD
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Gender | Male
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Dates
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Enumeration Date | 12/28/2005
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Last Update Date | 05/24/2022
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Provider Practice Location Address
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Address Line | 3710 SW US VETERANS HOSPITAL RD
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City | PORTLAND
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State | OR
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Zip | 97239-2964
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Country | US
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Telephone | 503-220-8262
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Fax |
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Provider Business Mailing Address
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Address Line | 2626 SW SHERWOOD PL
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City | PORTLAND
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State | OR
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Zip | 97201-2285
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Country | US
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Telephone | 215-313-9651
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD073837L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | C140172
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 4301115779
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 4301115779
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License Number State | MI
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Taxonomy #5
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 4301115779
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License Number State | MI
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Taxonomy #6
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Taxonomy Code | 2084P0802X
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Taxonomy Name | Addiction Psychiatry Physician
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License Number | 4301115779
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License Number State | MI
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Taxonomy #7
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD203430
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License Number State | OR
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