Provider Demographics
NPI:1760030647
Name:PRICE, BLAINE WESLEY (CSFA)
Entity Type:Individual
Prefix:
First Name:BLAINE
Middle Name:WESLEY
Last Name:PRICE
Suffix:
Gender:M
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10715 S VAN TRAP SPRING DR
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:AZ
Mailing Address - Zip Code:85641
Mailing Address - Country:US
Mailing Address - Phone:520-210-2287
Mailing Address - Fax:
Practice Address - Street 1:1551 E. TANGERINE RD ORO VALLEY HOSPITAL
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85755
Practice Address - Country:US
Practice Address - Phone:520-901-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2022-03-03
Deactivation Date:2021-01-22
Deactivation Code:
Reactivation Date:2022-03-01
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical