Anderson, Blake

Anderson, Blake is an individual health care provider with primary practice located at 1344 Red Oak Plantation Dr , Ballwin MO 63021-7346. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Emergency Medicine. Allopathic & Osteopathic Physicians / Family Medicine is his primary health care specialty. Anderson, Blake can be contacted via phone (314) 591-3417.

Contact Information

Primary practice address
1344 Red Oak Plantation Dr Ballwin MO 63021-7346
Phone: (314) 591-3417
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 2009013290 Missouri
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 2009013290 Missouri

Profile Details

NPI number 1093798134
LBN Legal business name Anderson, Blake
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 22nd, 2005
Last updated Apr 8th, 2014 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1093798134 NPPES
Minnesota Other 01-13048 MEDICA
Minnesota Other MH9041023739 MEDICA
Minnesota MEDICAID 1093798134 MEDICA
Minnesota MEDICAID 150459 MEDICA
Minnesota Other 67Q18AN MEDICA
Minnesota Other A035 MEDICA
Minnesota MEDICAID 16690100 MEDICA
Minnesota Other 1019018 MEDICA
Minnesota Other 7291 MEDICA
Minnesota Other 21955 MEDICA
Minnesota Other HP30702 MEDICA

Popular Providers