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General NPI Number Information
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NPI Number | 1760605455
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Entity Type | Individual
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Provider Name | ROBERT ERNEST BLEASE MD
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Gender | Male
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 04/26/2024
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Provider Practice Location Address
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Address Line | 2177 W IRONWOOD CENTER DR
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City | COEUR D ALENE
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State | ID
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Zip | 83814-2639
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Country | US
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Telephone | 208-625-6111
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Fax | 208-625-6112
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Provider Business Mailing Address
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Address Line | 2003 KOOTENAI HEALTH WAY
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City | COEUR D ALENE
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State | ID
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Zip | 83814-6051
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Country | US
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Telephone | 208-625-6111
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Fax | 208-625-6112
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | MED-PHYS-LIC-69984
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 207XX0801X
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Taxonomy Name | Orthopaedic Trauma Physician
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License Number | ME108720
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | M-16171
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License Number State | ID
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