Provider Demographics
NPI:1578873758
Name:BABCOCK, BLAKE DEWAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:DEWAYNE
Last Name:BABCOCK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9399 CROWN CREST BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-8508
Mailing Address - Country:US
Mailing Address - Phone:303-805-1855
Mailing Address - Fax:303-805-4421
Practice Address - Street 1:9399 CROWN CREST BLVD STE 220
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-8508
Practice Address - Country:US
Practice Address - Phone:303-805-1855
Practice Address - Fax:303-805-4421
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA1465232086X0206X
FLME1415012086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Multi-Specialty