Blake, George B

Blake, George B is an individual health care provider with primary practice located at 605 S Fremont Ave Suite A, Tampa FL 33606-2479. He recently has only one registered license in Allopathic & Osteopathic Physicians / Otolaryngology, which is considered as his primary health care specialty. Blake, George B can be contacted via phone (813) 251-0209.

Contact Information

Primary practice address
605 S Fremont Ave Suite A Tampa FL 33606-2479
Phone: (813) 251-0209
Fax: (813) 258-0600
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Otolaryngology 207Y00000X ME66396 Florida

Profile Details

NPI number 1962449587
LBN Legal business name Blake, George B
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 1st, 2006
Last updated Jan 17th, 2012 - about 12 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1962449587 NPPES
Florida MEDICAID 379713900

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