BLAKE TAYLOR WALLACE DPM NPI 1083216949

NPI Information

  • NPI: 1083216949
  • Provider Name: BLAKE TAYLOR WALLACE, DPM
  • Classification: Podiatrist - 213ES0103X
  • Specialization: Foot & Ankle Surgery
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 15601 N 28TH AVE STE 102
    PHOENIX, AZ
    ZIP 85053
  • Phone: (480) 844-8218

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NPI Details

Blake Taylor Wallace, DPM is a foot and ankle surgery podiatrist in Phoenix, AZ with 5 years of experience. Blake Taylor Wallace, DPM NPI is 1083216949. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: CALIFORNIA SCHOOL OF PODIATRIC MEDICINE
Graduation Year:2021

The provider's business location address is:

15601 N 28TH AVE STE 102
PHOENIX, AZ
ZIP 85053-061
Phone: (480) 844-8218

The NPI 1083216949 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).

The enumeration date for this NPI number is 11/14/2020 and was last updated on 7/29/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1213ES0103XPodiatristFoot & Ankle SurgeryPOD-001117ARIZONAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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