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

Dr. John S Blake, MD

Individual provider MOHS-Micrographic Surgery Physician · NPI 1508826587

Dr. John S Blake, MD is a Dermatology in Roosevelt, Utah. Graduated from University of Utah School of Medicine in 1988, 38 years ago. Practices with Northeastern Utah Medical Group, a 51-clinician group and accepts Medicare assignment. Licensed in Utah.

Years since qualifying
38
Trained at
University of Utah School of Medicine
Licensed in
UT
In the registry since
2006
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

See every abbreviation used in this directory →

Practice location Address checks out

210 W 300 N 7-3
Roosevelt, UT 84066
Phone: (435) 722-3971
Fax: (435) 722-6104
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

MOHS-Micrographic Surgery Physician (primary) Taxonomy 207ND0101X · Licence 49109901205 (UT)

Record details

NPI number1508826587
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorYes
NPI enumeratedMarch 24, 2006
Last updated in NPPESMay 2, 2017
Mailing address210 W 300 N 7-3, Roosevelt, UT 84066

Medicare enrollment

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

Medicare specialtyDERMATOLOGY
Medical schoolUNIVERSITY OF UTAH SCHOOL OF MEDICINE
Graduated 1988 (38 years in practice)
Group practice Northeastern Utah Medical Group — 51 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare