Provider Demographics
NPI:1588752984
Name:BLAS, MARK LOUIS (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:LOUIS
Last Name:BLAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4600 W NEWBERRY RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-2247
Mailing Address - Country:US
Mailing Address - Phone:352-367-2310
Mailing Address - Fax:352-367-2512
Practice Address - Street 1:4600 W NEWBERRY RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-2247
Practice Address - Country:US
Practice Address - Phone:352-367-2310
Practice Address - Fax:352-367-2512
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME73500207L00000X, 207LC0200X, 207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
No207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252191100Medicaid
FL252191100Medicaid
FL68841AMedicare PIN
G50088Medicare UPIN