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NPI Code Detail

MEDICARE: DR. RICHARD LAWRENCE BLAKE D.P.M.

MEDICARE: DR. RICHARD LAWRENCE BLAKE D.P.M.
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
1213E00000XPodiatristE2437CA

General Provider Information

NPI Number : 1770559924
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RICHARD LAWRENCE BLAKE D.P.M.
Provider Business Mailing Address
First Line : 900 HYDE ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94109-4806
Country : US
Telephone Number : 415-353-6400
Fax Number : 415-353-6401
Provider Business Practice Location Address
First Line : 900 HYDE ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94109-4806
Country : US
Telephone Number : 415-353-6400
Fax Number : 415-353-6401
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2006
Last Update Date : 04/30/2008

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