Provider Demographics
NPI:1043445091
Name:SANDALL, BLAIR JAMES (DPM)
Entity Type:Individual
Prefix:DR
First Name:BLAIR
Middle Name:JAMES
Last Name:SANDALL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1347 N GREENFIELD RD
Mailing Address - Street 2:STE 101
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-4072
Mailing Address - Country:US
Mailing Address - Phone:480-382-6619
Mailing Address - Fax:866-646-5962
Practice Address - Street 1:1347 N. GREENFIELD RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-4072
Practice Address - Country:US
Practice Address - Phone:480-699-8762
Practice Address - Fax:480-699-8350
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ0704213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ531450Medicaid
AZP01291786Medicare PIN
AZZ146112Medicare PIN