Jacob Blake, MD LTD.

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

License

11407 Issued in NV

Legal business name

JACOB BLAKE, MD LTD.

Doing business as

Sierra Peak Pain Management

Practice address

5590 Kietzke Lane
Reno, NV 89511

Phone

(775) 323-2080

Fax

(775) 323-8216

NPI assigned

Jan 18, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Kendall Quinlan

Title

Credentialing

Phone

(775) 720-1573

Specialties & licenses 1

Addresses

Other names 1

• Sierra Peak Pain Management Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1516233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1154839637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5590 KIETZKE LN",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895113019",
            "telephone_number": "775-323-2080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5590 KIETZKE LANE",
            "city": "RENO",
            "state": "NV",
            "postal_code": "89511",
            "telephone_number": "775-323-2080",
            "fax_number": "775-323-8216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACOB BLAKE, MD LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-18",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "QUINLAN",
        "authorized_official_first_name": "KENDALL",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "775-720-1573",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "NV",
            "license": "11407",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sierra Peak Pain Management",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Monisa Jackson
• Rose Denise Jackson
• Teresa Jackson
• Theta Jackson
• William Spencer Jackson, PHD
• Crista A Jacobe-Mann, RPT
• Randall N Jacobe, RPT
• Darryl Anthony Jacobs
• Jeanette Jacobs
• Negar Nicole Jacobs, PH.D.

• Pain Medicine (Anesthesiology) Physician in Reno, NV
• Providers in Reno, NV by specialty
• Pain Medicine (Anesthesiology) Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.