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Contact Information

RUSSELL R BLAKELEY, MD
606 N THIRD AVE
SUITE 203
SANDPOINT, ID83864-1594
 Phone: 208-263-8505
 Fax: 208-263-2908
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Cardiovascular Disease

207RC0000X 11 Physician/Internal Medicine
Indicates primary specialty

NPI Profile & details for RUSSELL R BLAKELEY · (Male)

NPI # 1063409639
Status Active
Credentials MD
Entity Individual
Enumeration date 09/29/2005
Last updated 01/27/2016 - About 10 years ago
Sole proprietor 1 No
Identifiers
  • TN License # 16299
  • TN Medicaid 3859386
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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