Individual
BLAKE WILSON JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3580 W 9000 S, WEST JORDAN, UT 84088-8812
(801) 561-8888
(480) 507-2971
Mailing address
PO BOX 1847, GILBERT, AZ 85299-1847
(480) 507-2961
(480) 507-2971
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
6919190-1240
UT
207L00000X
Anesthesiology Physician
94-06211 TEMPORARY
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1841453362
—
UT
Enumeration date
03/30/2007
Last updated
06/19/2015
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