Provider Demographics
NPI:1154839637
Name:JACOB BLAKE, MD LTD.
Entity Type:Organization
Organization Name:JACOB BLAKE, MD LTD.
Other - Org Name:SIERRA PEAK PAIN MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:MRS
Authorized Official - First Name:KENDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-720-1573
Mailing Address - Street 1:5590 KIETZKE LN
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-3019
Mailing Address - Country:US
Mailing Address - Phone:775-323-2080
Mailing Address - Fax:
Practice Address - Street 1:5590 KIETZKE LANE
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511
Practice Address - Country:US
Practice Address - Phone:775-323-2080
Practice Address - Fax:775-323-8216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-18
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11407207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty