Provider Demographics
NPI:1386356657
Name:BECHTLE, BLAKE B (PA-C)
Entity type:Individual
Prefix:
First Name:BLAKE
Middle Name:B
Last Name:BECHTLE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10798 W OVERLAND RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-1329
Mailing Address - Country:US
Mailing Address - Phone:208-377-3368
Mailing Address - Fax:208-322-4691
Practice Address - Street 1:10798 W OVERLAND RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-1329
Practice Address - Country:US
Practice Address - Phone:208-377-3368
Practice Address - Fax:208-322-4691
Is Sole Proprietor?:No
Enumeration Date:2022-12-19
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDPA2489363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant