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General NPI Number Information
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NPI Number | 1467893131
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Entity Type | Individual
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Provider Name | BLAKE HINES DPM
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Gender | Male
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Dates
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Enumeration Date | 07/10/2013
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Last Update Date | 04/09/2018
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Provider Practice Location Address
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Address Line | 12201 PECOS ST STE 400
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City | WESTMINSTER
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State | CO
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Zip | 80234-3994
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Country | US
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Telephone | 417-389-2203
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Fax |
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Provider Business Mailing Address
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Address Line | 3306 ABBEY RD UNIT 713
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City | EVANS
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State | CO
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Zip | 80620-8623
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Country | US
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Telephone | 417-389-2203
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 2013024450
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License Number State | MO
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