BLAKE TAYLOR WALLACE

PHOENIX, AZ
NPI1083216949
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy213ES0103X Podiatrist, Foot & Ankle Surgery
(Licence: AZ  POD-001117)
Enumeration Date2020-11-14
Last Update Date2024-07-29
Business Address
BLAKE TAYLOR WALLACE DPM
15601 N 28TH AVE STE 102
PHOENIX, AZ 85053-4061
Phone number: 480-844-8218
Mailing Address
BLAKE TAYLOR WALLACE DPM
PO BOX 32611
BELFAST, ME 04915-0219
Phone number: 480-844-8218
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