Provider Demographics
NPI:1770909293
Name:BLOXHAM, BLAKE
Entity type:Individual
Prefix:
First Name:BLAKE
Middle Name:
Last Name:BLOXHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 N 44TH ST APT 2067
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-5714
Mailing Address - Country:US
Mailing Address - Phone:714-293-0013
Mailing Address - Fax:
Practice Address - Street 1:GEISINGER MEDICAL CTR
Practice Address - Street 2:100 NORTH ACADEMY AVENUE
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822-0001
Practice Address - Country:US
Practice Address - Phone:570-271-6211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-07
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program