Individual
DANIEL STEPHEN BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SURGICAL FIRST ASST
Contact information
Practice address
1839 E ENROSE ST, MESA, AZ 85203-5822
(480) 220-8496
Mailing address
1839 E ENROSE ST, MESA, AZ 85203-5822
(480) 220-8496
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
F01309
AZ
Other
Enumeration date
08/07/2006
Last updated
09/16/2019
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