Scott M Blake
Oral and Maxillofacial Pathology
333 S Woodruff Ave
Idaho Falls
, Idaho 83401-4322
Scott M Blake
Oral and Maxillofacial Pathology
333 S Woodruff Ave
Idaho Falls
, Idaho 83401-4322
(208) 552-8079
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About
Features
Specialties
- Oral and Maxillofacial Pathology
Languages spoken
- English
Location
First Address
- Scott M Blake
- 333 S Woodruff Ave
- Idaho Falls, ID
- Zip : 83401-4322
- Fax : (208) 552-8079
- Phone : (208) 523-2160
Second Address
- Scott M Blake
- 333 S Woodruff Ave
- Idaho Falls, ID
- Zip : 83401-4322
- Fax : (208) 552-8079
- Phone : (208) 523-2160
Reviews
FAQs
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What type of doctor is Scott M Blake
In what state does Scott M Blake practice in?
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What is Scott M Blake ’s gender?
Is Scott M Blake a sole practitioner?
Is Scott M Blake accepting new patients?
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 1223P0106X | Oral and Maxillofacial Pathology | D3728 | ID |
National Provider Identifier
| NPI | 1376684175 |
|---|---|
| Provider Name | Scott M Blake |
| First Address | Idaho Falls, ID 83401-4322 |
| Second Address | Idaho Falls, ID 83401-4322 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 12/02/2007 |
| Last Update Date | 15/10/2015 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 000010143970 | REGENCE BLUE SHIELD (01) | ID |
| 118557800 | (05) | WY |
| 1504752 | UNITED CONCORDIA (01) | ID |
| 6I468 | FEDERAL BLUE CROSS (01) | ID |
| 6M014 | (02) | ID |
| 806657300 | (05) | ID |
| 806720800 | (05) | ID |
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.