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General NPI Number Information
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NPI Number | 1447588280
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Entity Type | Organization
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Legal Business Name | BLAKE D. ALEXANDER, MD PC
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Dates
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Enumeration Date | 12/04/2009
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Last Update Date | 12/04/2009
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Provider Practice Location Address
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Address Line | 1101 STANDIFORD AVE SUITE A-3
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City | MODESTO
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State | CA
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Zip | 95350-0982
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Country | US
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Telephone | 209-578-5072
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Fax | 209-578-5292
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Provider Business Mailing Address
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Address Line | 1101 STANDIFORD AVE SUITE A-3
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City | MODESTO
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State | CA
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Zip | 95350-0982
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Country | US
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Telephone | 209-578-5072
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Fax | 209-578-5292
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Authorized Official
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Title or Position | OWNER
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Name | BLAKE D. ALEXANDER
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Credential | M.D.
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Telephone | 209-578-5072
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | C52849
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | C52849
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License Number State | CA
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