Blake, Roger Alan

Blake, Roger Alan is an sole proprietor health care provider with primary practice located at 907 E Sunflower Rd 101, Cleveland MS 38732-2830. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Surgical Critical Care. Allopathic & Osteopathic Physicians / Surgical Critical Care is his primary health care specialty. Blake, Roger Alan can be contacted via phone (662) 846-8880.

Contact Information

Primary practice address
907 E Sunflower Rd 101 Cleveland MS 38732-2830
Phone: (662) 846-8880
Fax: (662) 846-8886
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 16881 Mississippi
Allopathic & Osteopathic Physicians / Surgical Critical Care 2086S0102X MC-2670 Idaho

Profile Details

NPI number 1023049335
LBN Legal business name Blake, Roger Alan
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 5th, 2006
Last updated Mar 4th, 2024 - about last year

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 1023049335 NPPES
Mississippi MEDICAID 00122620
Mississippi Other 7887026

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