DR. JOHN S BLAKE (NPI# 1508826587) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1508826587 |
Entity Type | Individual |
Full Name | DR. JOHN S BLAKE |
Credential | MD |
Practice Address |
210 W 300 N 7-3 Roosevelt UT 84066 |
Practice Telephone | 4357223971 |
Practice Fax Number | 4357226104 |
Mailing Telephone | 4357223971 |
Mailing Fax Number | 4357226104 |
Enumeration Date | 2006-03-24 |
Last Update Date | 2017-05-02 |
Gender Code | M |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
49109901205 | UT | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
UT | D3948 | 05 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1760874135 | John Scott Blake | Pharmacist | 624 Texas St Apt 403, Shreveport, LA 71101-3553 | 2015-02-23 |
1780726570 | John A Blake | Physician Assistant | 712 Village Rd Sw Ste 104, Shallotte, NC 28470-3449 | 2007-02-12 |
1982705877 | John Robert Blake | Psychiatry & Neurology | 170 Cold Soil Rd, Princeton, NJ 08540-4202 | 2006-09-26 |
1447220363 | John R Blake Jr. | Family Medicine | 4306 Asheville Hwy, Knoxville, TN 37914-3601 | 2006-01-24 |
1598039729 | John Robert Blake | Pharmacist | 929 Nw Garden Valley Blvd, Roseburg, OR 97471-6508 | 2012-03-06 |
1497938096 | John Blake | Nurse Practitioner | 2605 W Swann Ave, Ste 600, Tampa, FL 33609-4039 | 2007-12-06 |
1629290689 | John Everett Blake IIi | Anesthesiology | 281 N. Lyerly St., Suite 200, Chattanooga, TN 37404 | 2007-05-02 |
1861510570 | John L. Blake | Dentist | 455 E Columbia St, Long Beach, CA 90806-1620 | 2007-03-27 |
1114058401 | John Scott Blake | Physical Therapy Assistant | 501 E Main St, Waynesboro Hospital - Physical Medicine Department, Waynesboro, PA 17268-2353 | 2007-03-08 |
1184785149 | John Paul Blake I | Psychiatry & Neurology | 211 S Centennial St, High Point, NC 27260-5215 | 2006-12-13 |
Street Address |
210 W 300 N 7-3 |
City | ROOSEVELT |
State | UT |
Zip Code | 84066 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1982664199 | Northeastern Utah Medical Group | Dermatology | 210 W 300 N 7-3, Roosevelt, UT 84066 | 2006-03-23 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1477075315 | Annemarie Rousseau | Registered Nurse | 250 West 300 North, Roosevelt, UT 84066 | 2017-07-12 |
1780036772 | Drew Gilley | Dentist | 375 E Lagoon St, Roosevelt, Ut 84066, Roosevelt, UT 84066 | 2016-07-01 |
1952758039 | Amanda Adams | Massage Therapist | 1151 East Hwy 40, Ballard, UT 84066 | 2016-05-19 |
1447624325 | Gregory George Page | Dentist | 209 West 200 North 71-2, Roosevelt, UT 84066 | 2015-11-16 |
1659785772 | Becky Ann Birch | Nurse Practitioner | 200 West 350 North, Ste 103, Roosevelt, UT 84066 | 2014-06-17 |
1760724280 | Novo Ranch LLC | Residential Treatment Facility, Emotionally Disturbed Children | 3549 W 1000 North, Roosevelt, UT 84066 | 2013-03-22 |
1508110040 | Uintah Basin Spine and Disc Center, PC | Rehabilitation Unit | 1151 East Highway 40, Roosevelt, UT 84066 | 2012-11-06 |
1184918682 | Alvaro Beltran | Dentist | Ave. Lopez Mateos 171-4, Nogales, SONORA 84066 | 2011-06-02 |
1255638367 | Cosme Cantu | Dentist | Blvd. El Greco #45 Int. J-14, Nogales, SONORA 84066 | 2011-02-25 |
1740482009 | Northeastern Utah Medical Group | Durable Medical Equipment & Medical Supplies | 210 W 300 N 75 3, Roosevelt, UT 84066 | 2007-05-31 |
Find all providers in zip 84066 |
Taxonomy Code | 207ND0101X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Dermatology |
Specialization | MOHS-Micrographic Surgery |
The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S. |
Notes: Source: American College of Mohs Surgery, 2007 [1/1/2008: added definition, added source] Additional Resources: Additional Resources: http://www.mohscollege.org/; American Board of Dermatology, 2007. http://www.abderm.org/ |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1053823120 | Fife Dermatology Utah | Dermatology | 1490 E Foremaster Drive, Suite 260, St.george, UT 84790-4488 | 2017-10-30 |
1710242235 | Breton Adam Orel Yates | Dermatology | 1548 E 4500 S, Ste 202, Salt Lake City, UT 84117-5209 | 2012-07-10 |
1902171895 | M R Hinckley Md Pllc | Dermatology | 602 Fort Union Blvd, 2nd Floor, Midvale, UT 84047-2216 | 2012-03-12 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.