Provider Demographics
NPI:1003864802
Name:BLADE, KENT ALAN (MD)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:ALAN
Last Name:BLADE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5979 SEACREST VIEW RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-4355
Mailing Address - Country:US
Mailing Address - Phone:619-532-6702
Mailing Address - Fax:619-532-7272
Practice Address - Street 1:34800 BOB WILSON DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-1098
Practice Address - Country:US
Practice Address - Phone:619-532-6702
Practice Address - Fax:619-532-7272
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
PAMD 417456207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology