Blake, John S
Blake, John S is an sole proprietor health care provider with primary practice located at 210 W 300 N 7-3 , Roosevelt UT 84066. He recently has only one registered license in Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery, which is considered as his primary health care specialty. Blake, John S can be contacted via phone (435) 722-3971.Contact Information
Primary practice address
210 W 300 N 7-3
Roosevelt UT 84066
Phone: (435) 722-3971
Fax: (435) 722-6104
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery | 207ND0101X | 49109901205 | Utah |
Profile Details
| NPI number | 1508826587 |
|---|---|
| LBN Legal business name | Blake, John S |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Mar 24th, 2006 |
| Last updated | May 2nd, 2017 - about 7 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1508826587 | NPPES |
| Utah | MEDICAID | D3948 |
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