Individual
BLAZE COOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12605 E 16TH AVE, AURORA, CO 80045-2545
(720) 848-0000
Mailing address
1819 DENVER WEST DR STE 101, LAKEWOOD, CO 80401-3172
(303) 223-4448
(720) 501-5199
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
0444551
KS
2085R0202X
Diagnostic Radiology Physician
13455C
WY
2085R0202X
Diagnostic Radiology Physician
46788
CO
2085R0204X
Vascular & Interventional Radiology Physician
Primary
CDRH.0046788
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
17586798
—
CO
Enumeration date
01/30/2007
Last updated
04/21/2021
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