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General NPI Number Information
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NPI Number | 1699749804
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Entity Type | Individual
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Provider Name | JONATHAN M. BLATT M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/14/2006
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Last Update Date | 11/24/2009
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Provider Practice Location Address
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Address Line | 6542 SE LAKE RD. SUITE 202
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City | MILWAUKIE
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State | OR
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Zip | 97222
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Country | US
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Telephone | 503-654-5636
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Fax | 503-654-5638
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Provider Business Mailing Address
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Address Line | 6542 SE LAKE RD. SUITE 202
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City | MILWAUKIE
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State | OR
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Zip | 97222
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Country | US
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Telephone | 503-654-5636
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Fax | 503-654-5638
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | MD16764
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | MD16764
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License Number State | OR
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