Matthew Alexander Blake, IDC

Primary specialty

Independent Duty CorpsmanTaxonomy code 1710I1002X

Practice address

1336 Brunner St Apt H
San Diego, CA 92110-1690

Phone

(931) 865-6165

NPI assigned

Mar 13, 2018

Last updated

Mar 13, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1520899200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1520899200000",
    "number": "1699278952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1336 BRUNNER ST APT H",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921101690",
            "telephone_number": "931-865-6165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1336 BRUNNER ST APT H",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921101690",
            "telephone_number": "931-865-6165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "MATTHEW",
        "middle_name": "ALEXANDER",
        "name_prefix": "Mr.",
        "credential": "IDC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-13",
        "last_updated": "2018-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1002X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Corpsman",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Blake, PHARMD
• Brandon Blake
• Chrisjon Augustus Blake
• Denise M Blake, L.AC.
• Gary David Blake, M.D.
• Nathan Blake, PPS
• Patricia Blake, L.AC
• Patrick W Blake, MD
• Robert E Blake
• Ryan Matthew Blake, MD

• Independent Duty Corpsman in San Diego, CA
• Providers in San Diego, CA by specialty
• Independent Duty Corpsman in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.