Provider Demographics
NPI:1386812261
Name:BLAKE O ZOBELL DPM P C
Entity type:Organization
Organization Name:BLAKE O ZOBELL DPM P C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:ODELL
Authorized Official - Last Name:ZOBELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:435-896-6497
Mailing Address - Street 1:81 EAST 900 NORTH
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84701-1857
Mailing Address - Country:US
Mailing Address - Phone:435-896-6497
Mailing Address - Fax:
Practice Address - Street 1:81 EAST 900 NORTH
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-1857
Practice Address - Country:US
Practice Address - Phone:435-896-6497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2666400501213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT0942440001Medicare NSC
UTU44623Medicare UPIN