Provider Demographics
NPI:1205822665
Name:BLAKE, DANIEL R (DO)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:R
Last Name:BLAKE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3157 N RAINBOW BLVD # 518
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-4578
Mailing Address - Country:US
Mailing Address - Phone:702-386-4700
Mailing Address - Fax:702-386-4701
Practice Address - Street 1:7250 PEAK DR STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-9028
Practice Address - Country:US
Practice Address - Phone:702-386-4700
Practice Address - Fax:702-386-4701
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI2948207L00000X
NV1224207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100506317Medicaid
NVP00226099Medicare PIN