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General NPI Number Information
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NPI Number | 1689027054
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Entity Type | Individual
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Provider Name | BLAKE PETERSON DPM
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Gender | Male
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Dates
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Enumeration Date | 07/20/2016
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Last Update Date | 01/02/2026
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Provider Practice Location Address
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Address Line | 930 SW ABBEY ST STE A
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City | NEWPORT
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State | OR
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Zip | 97365-4820
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Country | US
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Telephone | 541-265-8816
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2847
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City | CORVALLIS
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State | OR
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Zip | 97339-2847
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Country | US
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Telephone |
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | T60-2016
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | DP207320
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 000930
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License Number State | AZ
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