Healthcare Provider Details

I. General information

NPI: 1861412769
Provider Name (Legal Business Name): BLAKE W. ARNOLD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 01/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 E MEDICAL CENTER DR
ST GEORGE UT
84790-2123
US

IV. Provider business mailing address

283 E 930 S
OREM UT
84058-5001
US

V. Phone/Fax

Practice location:
  • Phone: 435-673-4800
  • Fax:
Mailing address:
  • Phone: 801-225-6246
  • Fax: 801-225-1525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number363889-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number363889-1205
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number363889-1205
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number363889-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: