Dr. John S Blake
MOHS-Micrographic Surgeon
210 W 300 N 7-3
Roosevelt
, Utah 84066
Dr. John S Blake
MOHS-Micrographic Surgeon
210 W 300 N 7-3
Roosevelt
, Utah 84066
(435) 722-6104
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About
Features
Specialties
- MOHS-Micrographic Surgeon
Languages spoken
- English
Location
First Address
- Dr. John S Blake
- 210 W 300 N 7-3
- Roosevelt, UT
- Zip : 84066
- Fax : (435) 722-6104
- Phone : (435) 722-3971
Second Address
- Dr. John S Blake
- 210 W 300 N 7-3
- Roosevelt, UT
- Zip : 84066
- Fax : (435) 722-6104
- Phone : (435) 722-3971
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FAQs
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Is Dr. John S Blake a sole practitioner?
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207ND0101X | MOHS-Micrographic Surgeon | 49109901205 | UT |
National Provider Identifier
| NPI | 1508826587 |
|---|---|
| Provider Name | Dr. John S Blake |
| First Address | Roosevelt, UT 84066 |
| Second Address | Roosevelt, UT 84066 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 24/03/2006 |
| Last Update Date | 02/05/2017 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| D3948 | (05) | UT |
| E49176 | (02) | UT |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.