Provider Demographics
NPI:1780821413
Name:BLAKE, PATRICK JOSEPH III (HIS)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:JOSEPH
Last Name:BLAKE
Suffix:III
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 W SUNSET RD STE 110
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-6768
Mailing Address - Country:US
Mailing Address - Phone:702-566-8100
Mailing Address - Fax:702-383-8555
Practice Address - Street 1:1321 W SUNSET RD STE 110
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-6768
Practice Address - Country:US
Practice Address - Phone:702-566-8100
Practice Address - Fax:702-383-8555
Is Sole Proprietor?:No
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHAD5442237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist