Provider Demographics
NPI:1104267673
Name:BLAISE PODIATRY
Entity type:Organization
Organization Name:BLAISE PODIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAISE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:305-761-1262
Mailing Address - Street 1:9640 NW 10TH CT
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-4851
Mailing Address - Country:US
Mailing Address - Phone:305-424-9301
Mailing Address - Fax:305-424-9301
Practice Address - Street 1:3500 NW 17TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-5540
Practice Address - Country:US
Practice Address - Phone:305-761-1262
Practice Address - Fax:305-675-8164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-12
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3526213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty