DR. BLAKE COOPER CORCORAN (NPI# 1235490038) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235490038 |
| Entity Type | Individual |
| Full Name | DR. BLAKE COOPER CORCORAN |
| Credential | M.D. |
| Practice Address |
1125 Se Washington St. Pullman WA 99164 |
| Practice Telephone | 5093353575 |
| Practice Fax Number | 5093356223 |
| Mailing Telephone | 5093353575 |
| Mailing Fax Number | 5093356223 |
| Enumeration Date | 2012-06-07 |
| Last Update Date | 2019-08-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | MD600771757 | WA | Allopathic & Osteopathic Physicians |
| N | 207Q00000X | Family Medicine | MD458625 | PA | Allopathic & Osteopathic Physicians |
| Y | 207QS0010X |
Family Medicine Specialization: Sports Medicine |
MD60771757 | WA | Allopathic & Osteopathic Physicians |
| N | 207QS0010X |
Family Medicine Specialization: Sports Medicine |
MD458625 | PA | Allopathic & Osteopathic Physicians |
| Street Address |
1125 SE WASHINGTON ST. |
| City | PULLMAN |
| State | WA |
| Zip Code | 99164 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467408815 | William Thomas Gibson | Psychologist | 1125 Se Washington St., Pullman, WA 99111 | 2006-05-26 |
| 1700958493 | Petrina E Gavrilis | Nurse Practitioner | 1125 Se Washington St., Pullman, WA 99164 | 2006-11-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952837494 | Andrew Mutnan | Specialist/Technologist | 1547 Ne Colorado Street, Pullman, WA 99164 | 2017-05-03 |
| 1861866535 | Washington State University | Psychologist | 305 Ne Troy Mall, Pullman, WA 99164 | 2015-11-18 |
| 1174944169 | Cassie Marie Hodgin | Specialist/Technologist | 1455 Colorado St, Bohler Athletic Complex M4, Pullman, WA 99164 | 2013-12-18 |
| 1629364062 | Brenda Kay Deal Bye | Psychiatry & Neurology | Washington State University 1125 Se Washington St, Pullman, WA 99164 | 2011-06-23 |
| 1750914339 | Kalee Kennedy | Specialist/Technologist | Washington State University, 160 Cleveland Hall 1155 College Ave, Pullman, WA 99164 | 2020-02-21 |
| 1942541859 | Abby Myers Howard | Physician Assistant | 1125 Se Washington Street, Po Box 642302, Pullman, WA 99164 | 2013-03-04 |
| 1417261934 | Kyrsten E Stoops | Family Medicine | 1125 Se Washington St, Pullman, WA 99164 | 2010-07-27 |
| 1104071752 | Pam Spens | Nurse Practitioner | 1125 Se Washington St, Pullman, WA 99164 | 2008-11-24 |
| 1164039079 | Jalyn Rutledge | Specialist/Technologist | Bohler Athletic Complex Cougar Way - Wsu, Pullman, WA 99164-0001 | 2020-09-24 |
| 1154949733 | Washington State University | Clinical Medical Laboratory | Bustad Hall Room 155n, Pullman, WA 99164-0001 | 2020-07-09 |
| Find all providers in zip 99164 | ||||
| Taxonomy Code | 207QS0010X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Sports Medicine |
| A family medicine physician that is trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the health care of the individual engaged in physical exercise (sports) whether as an individual or in team participation. |
| 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 Family Medicine, 2007. http://www.theabfm.org/. American Osteopathic Board of Family Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326565110 | Family Care Network, Pllc | Family Medicine | 3130 Squalicum Pkwy Ste 110, Bellingham, WA 98225-1940 | 2017-08-23 |
| 1578682100 | Robert Stewart Nicol | Family Medicine | 23512 Ne 206th St, Battle Ground, WA 98604-9699 | 2007-03-28 |
| 1912033663 | Richard Terril Jacobs | Family Medicine | 1351 Fowler St, Richland, WA 99352-4714 | 2007-02-26 |
| 1821132481 | James E Hult | Family Medicine | 800 N 5th Ave # 101, Sequim, WA 98382-3045 | 2007-02-16 |
| 1598874430 | Patrick Z Pearce | Family Medicine | 730 N Hamilton St, Spokane, WA 99202-2045 | 2006-08-30 |
| 1265450514 | Lawrence J Greenblatt X | Family Medicine | 1407 116th Ave Ne Ste 102, Bellevue, WA 98004-3819 | 2006-07-17 |
| 1649211764 | Mark David Wagner | Family Medicine | 1000 Dexter Ave N Ste 320, Seattle, WA 98109-4878 | 2006-06-09 |
| 1528015229 | Public Hospital District #1 of King County | Family Medicine | 3600 Lind Ave Sw, Suite 170, Renton, WA 98055-4934 | 2006-05-28 |
| 1063486074 | Warren Billings Howe | Family Medicine | 516 High St, Wwu Student Health (ms-9132), Bellingham, WA 98225-5946 | 2006-02-15 |
| 1588280804 | Rainier Family and Sports Medicine P C | Family Medicine | 16202 64th St E Ste 104, Sumner, WA 98390-3028 | 2020-06-23 |
| Find all providers with the same taxonomy | ||||
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| 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.