Basic Information
| Provider Information | |||||||||
| NPI: | 1114307089 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RABE | ||||||||
| FirstName: | BLAKE | ||||||||
| MiddleName: | CRITCHLOW | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1587 E 275 N | ||||||||
| Address2: | |||||||||
| City: | LAYTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840404027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013367105 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1500 HIGHLANDS DR | ||||||||
| Address2: | |||||||||
| City: | LITITZ | ||||||||
| State: | PA | ||||||||
| PostalCode: | 175437694 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7176255000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2015 | ||||||||
| LastUpdateDate: | 06/04/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | OT016697 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.