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General NPI Number Information
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NPI Number | 1497650683
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Entity Type | Individual
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Provider Name | BLAKE ROGERS EMT
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Gender | Male
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Dates
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Enumeration Date | 10/09/2026
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Last Update Date | 10/09/2026
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Provider Practice Location Address
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Address Line | 123 W INDIANA AVE
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City | DELAND
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State | FL
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Zip | 32720-4615
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Country | US
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Telephone | 217-991-0635
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Fax | 217-991-0635
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Provider Business Mailing Address
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Address Line | 1271 CONTI AVE
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City | PORT ORANGE
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State | FL
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Zip | 32129-6007
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Country | US
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Telephone |
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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 | 146N00000X
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Taxonomy Name | Basic Emergency Medical Technician
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License Number | EMT599704
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License Number State | FL
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