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NPI Code Detail

MEDICARE: DR. MELISSA BLAKER DO

MEDICARE: DR. MELISSA BLAKER DO
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
1208G00000XThoracic Surgery (Cardiothoracic Vascular Surgery) Physician14206CA

General Provider Information

NPI Number : 1831332394
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MELISSA BLAKER DO
Provider Business Mailing Address
First Line : 801 S RANCHO DR STE E6
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-3812
Country : US
Telephone Number : 702-240-6482
Fax Number :
Provider Business Practice Location Address
First Line : 5225 S DURANGO DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89113-0137
Country : US
Telephone Number : 702-240-6482
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2009
Last Update Date : 08/23/2024

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