Blake, Wayne S
Blake, Wayne S is an individual health care provider with primary practice located at 1700 S Tamiami Trl , Sarasota FL 34239. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Blake, Wayne S can be contacted via phone (941) 917-4896.Contact Information
Primary practice address
1700 S Tamiami Trl
Sarasota FL 34239
Phone: (941) 917-4896
Fax: (941) 917-6884
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | OS 10255 | Florida |
Profile Details
| NPI number | 1588661185 |
|---|---|
| LBN Legal business name | Blake, Wayne S |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 28th, 2005 |
| Last updated | Aug 23rd, 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1588661185 | NPPES |
| Illinois | MEDICAID | 036093241 | |
| Illinois | Other | 90278 | |
| Illinois | MEDICAID | 280257100 |
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