Individual
PAUL ANTHONY BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
123 N CENTENNIAL WAY, STE 252, MESA, AZ 85201-6693
(480) 834-8802
(480) 834-8448
Mailing address
123 N CENTENNIAL WAY, STE 252, MESA, AZ 85201-6693
(480) 834-8802
(480) 834-8448
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
14159
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
230673
—
AZ
Enumeration date
08/31/2005
Last updated
03/02/2010
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