Individual
BLAKE PAUL GILLETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
325 W CENTER ST, SPANISH FORK, UT 84660-2060
(801) 798-7301
Mailing address
325 W CENTER ST, SPANISH FORK, UT 84660-2060
(801) 798-7301
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
3615241205
UT
207X00000X
Orthopaedic Surgery Physician
53004
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ENROLLED
—
IA
05
—
ENROLLED
—
MN
Enumeration date
06/30/2009
Last updated
08/26/2015
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