MEDICARE: DAVID ALLEN BLAKE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	A77088	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00A770880	OTHER	CA	BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326054255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID ALLEN BLAKE M.D.

Provider Business Mailing Address
First Line	:	225 S LAKE AVE
Second Line	:	535
City	:	PASADENA
State	:	CA
Zip	:	91101-3005
Country	:	US
Telephone Number	:	626-795-6596
Fax Number	:	626-795-8247

Provider Business Practice Location Address
First Line	:	225 S LAKE AVE
Second Line	:	SUITE 535
City	:	PASADENA
State	:	CA
Zip	:	91101-3005
Country	:	US
Telephone Number	:	626-795-6596
Fax Number	:	626-396-0851

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	09/26/2023

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Directions to “ DAVID ALLEN BLAKE M.D.” Practice Location

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