Provider Demographics
NPI:1568496727
Name:BLAKE, DAHLIA ANN (MD)
Entity Type:Individual
Prefix:
First Name:DAHLIA
Middle Name:ANN
Last Name:BLAKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 JOHNSON ST
Mailing Address - Street 2:MEMORIAL REGIONAL HOSPITAL DEPT. CRITICAL CARE
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-5421
Mailing Address - Country:US
Mailing Address - Phone:954-265-9976
Mailing Address - Fax:954-965-5396
Practice Address - Street 1:3501 JOHNSON ST
Practice Address - Street 2:MEMORIAL REGIONAL HOSPITAL DEPT. CRITICAL CARE
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5421
Practice Address - Country:US
Practice Address - Phone:954-265-9976
Practice Address - Fax:954-965-5396
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2004-01370173F00000X, 207RP1001X
FLME86801207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No173F00000XOther Service ProvidersSleep Specialist, PhD
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266289200Medicaid
FL266289200Medicaid