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Individual

DWIGHT STEPHEN BLEASE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.P.M.

Contact information

Practice address
10 CUSHING ST, BRUNSWICK, ME 04011-1801
(207) 725-2800
(207) 725-5953
Mailing address
10 CUSHING ST, BRUNSWICK, ME 04011-1801
(207) 725-2800
(207) 725-5953

Taxonomy

Speciality
Code
Description
License number
State
213ES0000X
Sports Medicine Podiatrist
ME POD 204
ME
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
ME POD 204
ME

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000942
ANTHEM
ME
01
010446440
TAX ID #
ME
01
T31402
HARVARD
ME
Enumeration date
10/02/2006
Last updated
09/06/2012
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