KENT WILLIAM BLAKELY (NPI# 1134222458) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134222458 |
| Entity Type | Individual |
| Full Name | KENT WILLIAM BLAKELY |
| Credential | MD |
| Practice Address |
1701 4th St Ste 210 Santa Rosa CA 95404 |
| Mailing Address |
3536 Mendocino Ave Ste 200 Santa Rosa CA 95403-3634 |
| Practice Telephone | 7075736942 |
| Practice Fax Number | 7075756038 |
| Mailing Telephone | 7075256485 |
| Mailing Fax Number | 7075736918 |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2019-07-01 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RR0500X |
Internal Medicine Specialization: Rheumatology |
G162755 | CA | Allopathic & Osteopathic Physicians |
| Street Address |
1701 4TH ST STE 210 |
| City | SANTA ROSA |
| State | CA |
| Zip Code | 95404 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104824994 | Jack Waxman | Internal Medicine | 1701 4th St Ste 210, Santa Rosa, CA 95404-3661 | 2005-07-14 |
| 1871008318 | Northern California Medical Assoc Inc | Dietitian, Registered | 1701 4th St Ste 210, Santa Rosa, CA 95404-3661 | 2017-12-06 |
| 1801348859 | Heather Jeanne Kehres | Physician Assistant | 1701 4th St Ste 210, Santa Rosa, CA 95404-3661 | 2016-10-25 |
| 1639620768 | Jennifer L Logan | Dietitian, Registered | 1701 4th St Ste 210, Santa Rosa, CA 95404-3661 | 2016-10-24 |
| 1477965507 | Isha Shrestha | Internal Medicine | 1701 4th St Ste 210, Santa Rosa, CA 95404-3661 | 2014-05-23 |
| 1497739114 | Yuichiro David Nakai | Internal Medicine | 1701 4th St Ste 210, Santa Rosa, CA 95404-3661 | 2005-12-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205442217 | David Lee Dutton | Counselor | 201 S. E Street, Santa Rosa, CA 95404 | 2020-09-16 |
| 1114492162 | Jesse Earl Rathbun Jr. | Ophthalmology | 1920 Grace Dr., Santa Rosa, CA 95404 | 2018-10-05 |
| 1568958437 | Bianca Avina | Marriage & Family Therapist | 95 Montgomery Dr. #112, Santa Rosa, CA 95404 | 2018-07-03 |
| 1366940504 | New Leaf Counseling and Psychotherapy | Marriage & Family Therapist | 1030 2n Street, Suite B, Santa Rosa, CA 95404 | 2018-01-23 |
| 1659884864 | Jessica Vargas Lopez | Counselor | 3333 Chanate Road, Santa Rosa, CA 95404 | 2017-11-09 |
| 1982135992 | Gaea Keridwyn Coon | Marriage & Family Therapist | 884 Third Street, Suite D, Santa Rosa, CA 95404 | 2017-03-22 |
| 1376084699 | Empire Traditional Chinese Medicine | Acupuncturist | 1030 Second St, Santa Rosa, CA 95404 | 2017-03-20 |
| 1356888705 | Webster Surgery Center, Lp | Clinic/Center | 730 Bennett Valley Road, Santa Rosa, CA 95404 | 2017-01-24 |
| 1205295979 | Sandra Lee Krikorian | Social Worker | 101 E Street, Suite 312, Santa Rosa, CA 95404 | 2016-02-23 |
| 1396134615 | The Center for Body Oriented Psychotherapy & Wellness | Psychologist | 1626 Fourth Street, Santa Rosa, CA 95404 | 2015-01-12 |
| Find all providers in zip 95404 | ||||
| Taxonomy Code | 207RR0500X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Rheumatology |
| An internist who treats diseases of joints, muscle, bones and tendons. This specialist diagnoses and treats arthritis, back pain, muscle strains, common athletic injuries and "collagen" diseases. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639516149 | Donald Lloyd Whisler | Internal Medicine | 500 Doyle Park Dr Ste 300, Santa Rosa, CA 95405-4559 | 2013-05-24 |
| 1841494275 | Lisa B. Kremer, M.d. | Internal Medicine | 4725-a Hoen Ave, Santa Rosa, CA 95405-7862 | 2007-06-11 |
| 1144262213 | Lisa B Kremer | Internal Medicine | 4725 Hoen Ave Ste A, Santa Rosa, CA 95405-9405 | 2006-06-12 |
| 1104824994 | Jack Waxman | Internal Medicine | 1701 4th St Ste 210, Santa Rosa, CA 95404-3661 | 2005-07-14 |
| 1891344305 | Northern California Medical Assoc Inc | Internal Medicine | 4690 Hoen Ave, Santa Rosa, CA 95405-7823 | 2019-09-06 |
| 1710457361 | Northern California Medical Assoc | Internal Medicine | 1701 4th St Ste 100, Santa Rosa, CA 95404-3661 | 2018-11-27 |
| 1588164909 | Northern California Medical Assoc Inc | Internal Medicine | 990 Sonoma Ave Ste 18, Santa Rosa, CA 95404 | 2018-02-13 |
| 1386031268 | David Maniscalco | Internal Medicine | 3883 Airway Dr Ste 130, Santa Rosa, CA 95403-1671 | 2015-04-19 |
| 1144592205 | Khashayar Khosraviani | Internal Medicine | 401 Bicentennial Way, Dept of Rheumatology Suite 160, Santa Rosa, CA 95403-2149 | 2012-02-06 |
| 1124102298 | Richard T. Zweig | Internal Medicine | 401 Bicentennial Way, Santa Rosa, CA 95403-2149 | 2006-10-25 |
| Find all providers in SANTA ROSA | ||||
| City | SANTA ROSA |
| Zip Code | 95404 |
Please comment or provide details below to improve the information on KENT WILLIAM BLAKELY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.