Individual
RICHARD W. BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3600 E WICKERSHAM WAY, WASILLA, AK 99654
(907) 373-5950
(907) 373-5954
Mailing address
3600 E WICKERSHAM WAY, WASILLA, AK 99654
(907) 373-5950
(907) 373-5954
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
482
AK
363AM0700X
Medical Physician Assistant
Primary
PADA482
AK
Other
Enumeration date
05/24/2006
Last updated
03/07/2023
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