Individual
BLAKE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MPAS, PA-C
Contact information
Practice address
777 BANNOCK ST, DENVER, CO 80204-4507
(303) 436-6000
Mailing address
475 N REDWOOD RD UNIT 16, SALT LAKE CITY, UT 84116-3565
(801) 584-9449
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/30/2022
Last updated
09/11/2024
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