Provider Demographics
NPI:1750692539
Name:BLAISE, ALEXANDER (DPM)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:BLAISE
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 1:9640 NW 10TH CT
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-4851
Mailing Address - Country:US
Mailing Address - Phone:305-424-9301
Mailing Address - Fax:305-424-9301
Practice Address - Street 1:3500 NW 17TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-5540
Practice Address - Country:US
Practice Address - Phone:305-761-1262
Practice Address - Fax:306-675-8164
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3526213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery