Individual provider · Type 1 NPI
Blake Taylor Wallace, DPM
Foot & Ankle Surgery Podiatrist · Phoenix, AZ
NPI number
1083216949
Active
Practice location
15601 N 28th Ave Ste 102
Phoenix, AZ 85053-4061
Mailing address
PO Box 32611
Belfast, ME 04915-0219
Other practice locations
- 3100 Telegraph Ave, Oakland, CA 94609-3239 · (800) 607-6377
- 8414 Naab Rd Ste 215, Indianapolis, IN 46260-1972 · (317) 338-7510
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Foot & Ankle Surgery Podiatrist Primary | 213ES0103X | POD-001117 (AZ) |
Foot & Ankle Surgery Podiatrist: Definition to come...
Another provider at this address
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About NPI 1083216949
Blake Taylor Wallace, DPM's National Provider Identifier is 1083216949, issued on Nov 14, 2020. The primary taxonomy on file is Foot & Ankle Surgery Podiatrist (213ES0103X), and the practice location is in Phoenix, AZ. The record was last updated on Jul 29, 2024.