Provider Demographics
NPI:1124580410
Name:SAVAGE, BLAKE THOMAS
Entity Type:Individual
Prefix:
First Name:BLAKE
Middle Name:THOMAS
Last Name:SAVAGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3175 SAINT ROSE PKWY STE 320
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3508
Mailing Address - Country:US
Mailing Address - Phone:702-997-9833
Mailing Address - Fax:702-997-9844
Practice Address - Street 1:3175 SAINT ROSE PKWY STE 320
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3508
Practice Address - Country:US
Practice Address - Phone:702-997-9833
Practice Address - Fax:702-666-0413
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103301343213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery