Provider Demographics
NPI:1225003700
Name:STAMPER, BLAKE A (DO)
Entity Type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:A
Last Name:STAMPER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27340
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85061-7340
Mailing Address - Country:US
Mailing Address - Phone:602-943-9200
Mailing Address - Fax:602-216-3200
Practice Address - Street 1:2000 HIGHWAY 95
Practice Address - Street 2:SUITE 200
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-6050
Practice Address - Country:US
Practice Address - Phone:928-758-1175
Practice Address - Fax:928-758-5191
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2533207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ130493Medicaid
AZ0893840001Medicare PIN
F09366Medicare UPIN
AZZWMBJH01Medicare PIN
AZ130493Medicaid