Healthcare Provider Details

I. General information

NPI: 1578873758
Provider Name (Legal Business Name): BLAKE DEWAYNE BABCOCK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9403 CROWN CREST BLVD STE 200COLO
PARKER CO
80138-8882
US

IV. Provider business mailing address

9399 CROWN CREST BLVD STE 220
PARKER CO
80138-8508
US

V. Phone/Fax

Practice location:
  • Phone: 303-320-0699
  • Fax:
Mailing address:
  • Phone: 303-805-1855
  • Fax: 303-805-4421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberME141501
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberDR.67355
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number146523
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: