Healthcare Provider Details

I. General information

NPI: 1740867076
Provider Name (Legal Business Name): JASON BLAKE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 TRUXTUN AVE
BAKERSFIELD CA
93301-3698
US

IV. Provider business mailing address

2215 TRUXTUN AVE
BAKERSFIELD CA
93301-3602
US

V. Phone/Fax

Practice location:
  • Phone: 661-632-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036.167471
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number125.078351
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number20A23608
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: