RICHARD W. BLAKE (NPI# 1740235829) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1740235829 |
Entity Type | Individual |
Full Name | RICHARD W. BLAKE |
Credential | PA-C |
Practice Address |
3600 E Wickersham Way Wasilla AK 99654 |
Practice Telephone | 9073735950 |
Practice Fax Number | 9073735954 |
Mailing Telephone | 9073735950 |
Mailing Fax Number | 9073735954 |
Enumeration Date | 2006-05-24 |
Last Update Date | 2019-10-09 |
Gender Code | M |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PADA482 | AK | Physician Assistants & Advanced Practice Nursing Providers |
N | 363AM0700X |
Physician Assistant Specialization: Medical |
482 | AK | Physician Assistants & Advanced Practice Nursing Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
AK | DEA NUMBER | MB0593726 | 01 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1174650071 | Richard Gary Blake | Technician/Technologist | 21835 Ventura Blvd, Woodland Hills, CA 91364-1838 | 2007-02-27 |
1972666774 | Richard Daniel Blake | Chiropractor | 8 Glen Road, Powerhouse Mall, W Lebanon, NH 03784 | 2006-12-19 |
1295358356 | Richard Andrew Blake | Pharmacist | 800 Glenwood Ave Se, Atlanta, GA 30316-1814 | 2020-05-24 |
1912921867 | Richard Wayne Blake | Dentist | 2701 Park Dr, Suite #1, Clearwater, FL 33763-1021 | 2006-07-26 |
1699702308 | Richard Alan Blake | Internal Medicine | 1401 Harrodsburg Rd, Suite A-300, Lexington, KY 40504-3751 | 2006-06-27 |
1770559924 | Richard Lawrence Blake | Podiatrist | 900 Hyde St, San Francisco, CA 94109-4806 | 2006-02-27 |
Street Address |
3600 E WICKERSHAM WAY |
City | WASILLA |
State | AK |
Zip Code | 99654 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1104317098 | Melissa E San Roman | Hearing Instrument Specialist | 3600 E Wickersham Way, Wasilla, AK 99654-7550 | 2018-05-25 |
1134523855 | Cottonwood Creek Clinic LLC | Internal Medicine | 3600 E Wickersham Way, Wasilla, AK 99654-7550 | 2014-10-09 |
1952659237 | Jodie H Escot | Hearing Instrument Specialist | 3600 E Wickersham Way, Wasilla, AK 99654-7550 | 2012-08-17 |
1124376405 | Raleen A Mccourry | Hearing Instrument Specialist | 3600 E Wickersham Way, Wasilla, AK 99654-7550 | 2012-08-17 |
1396093670 | James O Staengel | Hearing Instrument Specialist | 3600 E Wickersham Way, Wasilla, AK 99654-7550 | 2012-08-17 |
1831447119 | Otto Inc | Hearing Instrument Specialist | 3600 E Wickersham Way, Wasilla, AK 99654-7550 | 2012-08-17 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1003426784 | Colleen Maggie Newcity | Case Manager/Care Coordinator | 851 Westpoint Suite 310, Wasilla, AK 99654 | 2020-08-06 |
1659995884 | Amy M Lowe | Peer Specialist | 1363 W Spuce Ave, Wasilla, AK 99654 | 2020-06-03 |
1922648690 | Achieve Medical Alaska LLC | Clinic/Center | 1981 E Palmer, Suite 230, Wasilla, AK 99654 | 2020-01-10 |
1588205538 | Juan Carlos Garcia | Physician Assistant | 950 East Bogard Road, Suite 103, Wasilla, AK 99654 | 2019-10-01 |
1427610864 | Sharon Webb | Counselor | 705 S Knik Goose Bay Rd Suite K, Wasilla, AK 99654 | 2019-07-06 |
1306401864 | Logan Lee Cook | Peer Specialist | 2953 E Fairview Loop, Wasilla, AK 99654 | 2019-05-09 |
1053883595 | Moose Creek Medical Clinic LLC | Nurse Practitioner | 2341 S. Fern St., Suite 300, Wasilla, AK 99654 | 2018-12-21 |
1487124962 | Melissa A Stevens | Massage Therapist | 2201 W That Rd, Wasilla, AK 99654 | 2018-11-28 |
1609359561 | Audrey E Beers | Midwife | 2405 S. Knik Goose Bay Rd., Wasilla, AK 99654 | 2018-09-07 |
1093297418 | Karlee Janine Mccorry | Occupational Therapist | 613 S Knik-goose Bay Rd, Wasilla, AK 99654 | 2018-09-01 |
Find all providers in zip 99654 |
Taxonomy Code | 363AM0700X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Physician Assistant |
Specialization | Medical |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1912549098 | Craig Michael Brumagin | Physician Assistant | 4961 E Mayflower Ln, Wasilla, AK 99654-7708 | 2019-10-10 |
1528503687 | Northwoods Family Medicine, Inc | Physician Assistant | 1301 E. Palmer-wasilla Hwy, #400, Wasilla, AK 99654 | 2016-12-28 |
1669898474 | Louis Michael Smith | Physician Assistant | 22301 W Alsop Rd, Wasilla, AK 99623-5023 | 2014-03-17 |
1083701858 | Gerald Edward Manning II | Physician Assistant | 5050 Dunbar, Suite D, Wasilla, AL 99654 | 2006-10-05 |
1427049238 | Scott William Schafer | Physician Assistant | 3066 E Meridian Park Loop, Capstone Urgent Care, Wasilla, AK 99654-7372 | 2005-11-01 |
1043738461 | Nathan Fitzgerald | Physician Assistant | 22301 W Alsop Rd, Wasilla, AK 99623-5023 | 2017-09-06 |
1194119313 | Adrian Kristin Giani | Physician Assistant | 1700 E Bogard Rd Ste 102, Wasilla, AK 99654-6563 | 2015-03-25 |
1629461488 | David Arthur | Physician Assistant | 1001 S Knik Goose Bay Rd, Wasilla, AK 99654-8083 | 2015-03-17 |
1922498781 | Matthew Loudon | Physician Assistant | 3331 E Meridian Park Loop, Wasilla, AK 99654-7294 | 2015-02-02 |
1548426471 | Leah M Bramer | Physician Assistant | 1001 S Knik Goose Bay Rd, Wasilla, AK 99654-8083 | 2008-07-30 |
Find all providers in WASILLA |
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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.