Provider Demographics
NPI:1528287174
Name:BLAKELY, COLLIN (MD)
Entity type:Individual
Prefix:
First Name:COLLIN
Middle Name:
Last Name:BLAKELY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:505 PARNASSUS AVE
Mailing Address - Street 2:MOFFIT M1286
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-1270
Mailing Address - Country:US
Mailing Address - Phone:415-885-7276
Mailing Address - Fax:415-353-9615
Practice Address - Street 1:505 PARNASSUS AVE
Practice Address - Street 2:MOFFIT M1286
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2204
Practice Address - Country:US
Practice Address - Phone:415-885-7276
Practice Address - Fax:415-353-9615
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2009-06-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMT190228207R00000X
CAA106689207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine