Provider Demographics
NPI:1316350085
Name:SPITZER, BLAKE FRANCIS (MD)
Entity type:Individual
Prefix:
First Name:BLAKE
Middle Name:FRANCIS
Last Name:SPITZER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:786 THIRD AVE STE B
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-5826
Mailing Address - Country:US
Mailing Address - Phone:619-425-0797
Mailing Address - Fax:
Practice Address - Street 1:786 THIRD AVE STE B
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-5826
Practice Address - Country:US
Practice Address - Phone:619-425-0797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS94-08305208600000X
CAA158371208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty