Healthcare Provider Details

I. General information

NPI: 1770965865
Provider Name (Legal Business Name): BLAKE SAUL D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2015
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4212 W CONGRESS ST STE 3100
LAFAYETTE LA
70506-6771
US

IV. Provider business mailing address

4212 W CONGRESS ST STE 3100
LAFAYETTE LA
70506-6771
US

V. Phone/Fax

Practice location:
  • Phone: 337-703-3201
  • Fax: 337-703-3202
Mailing address:
  • Phone: 337-703-3201
  • Fax: 337-703-3202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number325883
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: