Provider Demographics
NPI:1174576144
Name:CASHMORE, BLAINE JOHNSON (MD)
Entity type:Individual
Prefix:DR
First Name:BLAINE
Middle Name:JOHNSON
Last Name:CASHMORE
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:196 E 2000 N STE 109
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-9335
Mailing Address - Country:US
Mailing Address - Phone:435-228-0061
Mailing Address - Fax:435-843-7135
Practice Address - Street 1:196 E 2000 N
Practice Address - Street 2:STE. 106
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-9335
Practice Address - Country:US
Practice Address - Phone:435-622-8006
Practice Address - Fax:435-882-8253
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2018-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT59686361205208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTI42963Medicare UPIN