3600 E WICKERSHAM WAY
WASILLA, AK 99654 US PECOS Enrolled
Richard W. Blake
Physician Assistant (Medical)
- WASILLA, AK
- Phone: (907)-373-5950
- Last Updated 3/7/2023
Overview
Richard W. Blake is a Physician Assistant (Medical) in the WASILLA area and has over 24 years of experience. Richard W. Blake primary office location is at 3600 E WICKERSHAM WAY and new patients are welcome to contact this healthcare provider for an appointment. He attended University Of North Dakota School Of Medicine and graduated 2000
Richard W. Blake is affiliated with two hospitals in the WASILLA area, including MAT-SU REGIONAL MEDICAL CENTER. The NPI number is 1740235829 and the information was updated approximately 1 year ago.
Richard W. Blake is affiliated with one medical group in the WASILLA area, COTTONWOOD CREEK CLINIC LLC.
We have not detected any Exclusions tied directly to this NPI.
Accepts Medicare Assignment: Unknown
Is sole proprietor: YES
Participates in PECOS: YES (See any PECOS details below)
Contact Information
| License Number | State |
|---|---|
| 482 | AK |
| PADA482 | AK |
No Identifiers found
| Taxonomy | State | Primary? |
|---|---|---|
| Physician Assistant (Medical) - Taxonomy Code 363AM0700X | AK | Y |
| Physician Assistant - Taxonomy Code 363A00000X | -- | N |
| Physician Assistant (Medical) - Taxonomy Code 363AM0700X | AK | N |
PECOS Details:
| Participates in PECOS: | YES |
| PECOS Individual Enrollment ID: | I20060608000043 |
| PECOS Individual PAC ID: | 8527070655 |
| Eligible to order/refer Part B Clinical Laboratory and Imaging | Yes |
| Eligible to order/refer Durable Medical Equipment (DME) | Yes |
| Eligible to order/refer Home Health Agency (HHA) | Yes |
| Eligible to order/refer Power Mobility Devices (PMD) | Yes |
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