# BLAKE WILSON JOHNSON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1760502991
- **Gender:** Man
- **Credential:** D.O.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | 012210 | AZ | — |
| 207L00000X | Anesthesiology Physician | 6919190-1240 | UT | Yes |
| 207L00000X | Anesthesiology Physician | 94-06211 TEMPORARY | KS | — |

## Other

- **Enumeration date:** 03/30/2007
- **Last updated:** 06/11/2026

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1841453362 | — | UT |