Thompson, Blake

Thompson, Blake is an individual health care provider with primary practice located at 1340 S 18Th St Ste 204 , Fernandina Beach FL 32034-4733. He recently has only one registered license in Allopathic & Osteopathic Physicians / Gastroenterology, which is considered as his primary health care specialty. Thompson, Blake can be contacted via phone (904) 398-7205.

Contact Information

Primary practice address
1340 S 18Th St Ste 204 Fernandina Beach FL 32034-4733
Phone: (904) 398-7205
Fax: (904) 277-7054
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Gastroenterology 207RG0100X ME167699 Florida

Profile Details

NPI number 1134624687
LBN Legal business name Thompson, Blake
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 27th, 2018
Last updated Jun 3rd, 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 1134624687 NPPES
Florida MEDICAID 122460200

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