Individual
DR. BLAKE PATRICK SAMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
UNIVERSITY OF UTAH DEPARTMENT OF DERMATOLOGY, 30 N 1900 E, SALT LAKE CITY, UT 84132-0001
(801) 581-6465
Mailing address
UNIVERSITY OF UTAH DEPARTMENT OF DERMATOLOGY, 30 N 1900 E, SALT LAKE CITY, UT 84132-0001
(801) 581-6465
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
91787531205
UT
207ND0101X
MOHS-Micrographic Surgery Physician
91787753
UT
207NS0135X
Procedural Dermatology Physician
91787753
UT
207R00000X
Internal Medicine Physician
MRM-1316
ID
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/09/2013
Last updated
05/09/2017
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