Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 56383 | TN |
Y | 207PE0004X | Emergency Medical Services | 67158 | MN |
N | 207PE0004X | Emergency Medical Services | 73693 | WI |
NPI | 1063808749 |
---|---|
Provider Name | Dr. Craig Blakeney |
First Address | Rochester, MN 55905-0001 |
Second Address | Rochester, MN 55905-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2015 |
Last Update Date | 02/11/2021 |