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General NPI Number Information
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NPI Number | 1770879843
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Entity Type | Individual
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Provider Name | BLAKE ROBERT OBROCK D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/27/2011
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Last Update Date | 11/29/2022
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Provider Practice Location Address
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Address Line | 1485 N TURQUOISE DR STE 200
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-2000
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Country | US
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Telephone | 928-774-7757
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Fax | 928-774-7767
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Provider Business Mailing Address
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Address Line | 18444 N 25TH AVE STE 310
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City | PHOENIX
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State | AZ
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Zip | 85023-1266
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Country | US
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Telephone | 928-774-7757
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Fax | 928-774-7767
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | R3726
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 008371
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License Number State | AZ
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