# BLAZE COOK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1437296704
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2085R0202X | Diagnostic Radiology Physician | 0444551 | KS | — |
| 2085R0202X | Diagnostic Radiology Physician | 13455C | WY | — |
| 2085R0202X | Diagnostic Radiology Physician | 46788 | CO | — |
| 2085R0204X | Vascular & Interventional Radiology Physician | CDRH.0046788 | CO | Yes |

## Other

- **Enumeration date:** 01/30/2007
- **Last updated:** 04/21/2021