Individual
MR. BLAKE DANIEL ALEXANDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1101 STANDIFORD AVE, SUITE A-3, MODESTO, CA 95350-0982
(209) 578-5072
(209) 578-5292
Mailing address
1101 STANDIFORD AVE, SUITE A-3, MODESTO, CA 95350-0982
(209) 578-5072
(209) 578-5292
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
C52849
CA
207ND0101X
MOHS-Micrographic Surgery Physician
C52849
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ48224Z
MEDICARE IDENTIFICATION #
CA
Enumeration date
07/26/2006
Last updated
09/03/2014
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