Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Blake Taylor Wallace, DPM

Individual provider Foot & Ankle Surgery Podiatrist · NPI 1083216949

Blake Taylor Wallace, DPM is a Podiatry in Phoenix, Arizona. Graduated from California School of Podiatric Medicine in 2021, 5 years ago. Practices with Desert Foot and Ankle P C, a 6-clinician group, works from 3 locations and accepts Medicare assignment. Licensed in Arizona.

Years since qualifying
5
Trained at
California School of Podiatric Medicine
Licensed in
AZ
In the registry since
2020
What do these letters mean?
DPM — Doctor of Podiatric Medicine
A foot and ankle physician and surgeon.

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Practice location Address checks out

15601 N 28th Ave Ste 102
Phoenix, AZ 85053-4061
Phone: (480) 844-8218
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 3100 Telegraph Ave, Oakland, CA 94609-3239 — (800) 607-6377
  • 8414 Naab Rd Ste 215, Indianapolis, IN 46260-1972 — (317) 338-7510

Specialties & licences

Foot & Ankle Surgery Podiatrist (primary) Taxonomy 213ES0103X · Licence POD-001117 (AZ)

Record details

NPI number1083216949
Entity typeIndividual (Type 1)
GenderMale
Credentials DPM
Sole proprietorYes
NPI enumeratedNovember 14, 2020
Last updated in NPPESJuly 29, 2024
Certification dateJuly 29, 2024
Mailing addressPo Box 32611, Belfast, ME 04915-0219

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPODIATRY
Medical schoolCALIFORNIA SCHOOL OF PODIATRIC MEDICINE
Graduated 2021 (5 years in practice)
Group practice Desert Foot And Ankle P C — 6 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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