Provider Demographics
NPI:1467893131
Name:HINES, BLAKE (DPM)
Entity Type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:
Last Name:HINES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3306 ABBEY RD UNIT 713
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:CO
Mailing Address - Zip Code:80620-8623
Mailing Address - Country:US
Mailing Address - Phone:417-389-2203
Mailing Address - Fax:
Practice Address - Street 1:12201 PECOS ST STE 400
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-3994
Practice Address - Country:US
Practice Address - Phone:417-389-2203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013024450213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery