# BLAKE R BURCHETT

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083902837
- **Authorized official:** DR. BLAKE R BURCHETT MD (OWNER)
- **Authorized official phone:** (606) 886-8466

## Contact information

- **Practice address:** 535 N LAKE DR, PRESTONSBURG, KY 41653-1278
- **Practice address phone:** (606) 886-8466
- **Practice address fax:** (606) 886-0250
- **Mailing address:** 535 N LAKE DR, PRESTONSBURG, KY 41653-1278
- **Mailing address phone:** (606) 886-8466
- **Mailing address fax:** (606) 886-0250

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/14/2011
- **Last updated:** 07/14/2011