Provider Demographics
NPI:1255532859
Name:CHRISTOPHER A. BLAKE, MD, PC
Entity type:Organization
Organization Name:CHRISTOPHER A. BLAKE, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-472-0423
Mailing Address - Street 1:355 SE BAKER ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-6039
Mailing Address - Country:US
Mailing Address - Phone:503-472-0423
Mailing Address - Fax:
Practice Address - Street 1:355 SE BAKER ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-6039
Practice Address - Country:US
Practice Address - Phone:503-472-0423
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR200001052OtherRAILROAD MEDICARE
OR228452Medicaid
OR228452Medicaid
OR228452Medicaid
OR131319Medicare ID - Type Unspecified
OR0307980001Medicare NSC