Daniel Stephen Blake, SURGICAL FIRST ASST

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

F01309 Issued in AZ

Practice address

1839 E Enrose St
Mesa, AZ 85203-5822

Phone

(480) 220-8496

NPI assigned

Aug 7, 2006

Last updated

Sep 16, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

State licenses

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

{
    "created_epoch": "1154908800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568592000000",
    "number": "1750390803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1839 E ENROSE ST",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852035822",
            "telephone_number": "480-220-8496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1839 E ENROSE ST",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852035822",
            "telephone_number": "480-220-8496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "DANIEL",
        "middle_name": "STEPHEN",
        "credential": "SURGICAL FIRST ASST",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-07",
        "last_updated": "2019-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "AZ",
            "license": "F01309",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maria Elaine Blahut
• Jackie Lynn Blair-Merritt, PT
• Debra Lynn Blair
• Julie Blair, LMSW
• Lindsay Deanna Blaire, M.S., CCC-SLP
• Paul Anthony Blake, MD
• Yuliya Blake
• India Blakely
• Eddie Lee Blakes Jr., DBH, LIAC
• Melissa Blanchard, M.ED.

• Surgical Physician Assistant in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Surgical Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2019; 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.