Blake, Thomas Harold

Blake, Thomas Harold is an individual health care provider with primary practice located at 424 S 13Th Ave , Laurel MS 39440-4345. He recently has only one registered license in Allopathic & Osteopathic Physicians / Orthopaedic Surgery, which is considered as his primary health care specialty. Blake, Thomas Harold can be contacted via phone (601) 399-6167.

Contact Information

Primary practice address
424 S 13Th Ave Laurel MS 39440-4345
Phone: (601) 399-6167
Fax: (601) 399-6281
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Orthopaedic Surgery 207X00000X 07473 Mississippi

Profile Details

NPI number 1558330415
LBN Legal business name Blake, Thomas Harold
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 14th, 2006
Last updated Feb 13th, 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1558330415 NPPES
Mississippi MEDICAID 00015289

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