Johnson, Blake Wilson

Johnson, Blake Wilson is an sole proprietor health care provider with primary practice located at 3580 W 9000 S , West Jordan UT 84088-8812. He recently has only one registered license in Allopathic & Osteopathic Physicians / Anesthesiology, which is considered as his primary health care specialty. Johnson, Blake Wilson can be contacted via phone (801) 561-8888.

Contact Information

Primary practice address
3580 W 9000 S West Jordan UT 84088-8812
Phone: (801) 561-8888
Fax: (480) 507-2971
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Anesthesiology 207L00000X 94-06211 TEMPORARY Kansas
Allopathic & Osteopathic Physicians / Anesthesiology 207L00000X 6919190-1240 Utah

Profile Details

NPI number 1760502991
LBN Legal business name Johnson, Blake Wilson
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 30th, 2007
Last updated Jun 19th, 2015 - about 9 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1760502991 NPPES
Utah MEDICAID 1841453362

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