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Individual
BLAKE WILSON JOHNSON
Active
Individual
BLAKE WILSON JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
012210
AZ
207L00000X
Anesthesiology Physician
Primary
6919190-1240
UT
207L00000X
Anesthesiology Physician
94-06211 TEMPORARY
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1841453362
—
UT
Enumeration date
03/30/2007
Last updated
06/11/2026
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