Illston, Blake Jeffrey

Illston, Blake Jeffrey is an sole proprietor health care provider with primary practice located at 300 W Hospital Rd , Fort Gordon GA 30905-5741. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Emergency Medical Services, Allopathic & Osteopathic Physicians / Emergency Medicine. Allopathic & Osteopathic Physicians / Emergency Medicine is his primary health care specialty. Illston, Blake Jeffrey can be contacted via phone (706) 787-9285.

Contact Information

Primary practice address
300 W Hospital Rd Fort Gordon GA 30905-5741
Phone: (706) 787-9285
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medical Services 207PE0004X RTP001882 Georgia
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 68035 Georgia

Profile Details

NPI number 1487876355
LBN Legal business name Illston, Blake Jeffrey
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 2nd, 2007
Last updated Mar 29th, 2023 - about 3 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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