Provider Demographics
NPI:1720026560
Name:ZOBELL, BLAKE O (DPM)
Entity Type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:O
Last Name:ZOBELL
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 1:879 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84701-1840
Mailing Address - Country:US
Mailing Address - Phone:435-896-6497
Mailing Address - Fax:435-896-9564
Practice Address - Street 1:879 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-1840
Practice Address - Country:US
Practice Address - Phone:435-896-6497
Practice Address - Fax:435-896-9564
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2666400501213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT0942440001Medicare NSC
UTU44623Medicare UPIN