Blake, Jeremy T.

Blake, Jeremy T. is an individual health care provider with primary practice located at 264 Coatsland Dr. , Jackson TN 38301. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Blake, Jeremy T. can be contacted via phone (731) 423-1500.

Contact Information

Primary practice address
264 Coatsland Dr. Jackson TN 38301
Phone: (731) 423-1500
Fax: (731) 423-0342
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X MD0000031623 Tennessee

Profile Details

NPI number 1770671018
LBN Legal business name Blake, Jeremy T.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 11th, 2006
Last updated Oct 17th, 2018 - about 6 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 1770671018 NPPES
Tennessee MEDICAID 5440909

Popular Providers