Provider Demographics
NPI:1629422522
Name:HAAS, BLAKE (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:
Last Name:HAAS
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 W CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-2386
Mailing Address - Country:US
Mailing Address - Phone:702-383-2000
Mailing Address - Fax:
Practice Address - Street 1:1800 W CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-2386
Practice Address - Country:US
Practice Address - Phone:702-383-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-17
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1710832085N0700X
NV218622085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiologyGroup - Single Specialty