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Organization
JON KEVIN BLAKE MD
Active
Organization
JON KEVIN BLAKE MD
Active
Other names
Jon K. Blake MD
Organization subpart
No
Provider details
NPI number
Authorized official
JON BLAKE MD (AUTHORIZED OFFICIAL/PHYSICIAN)
(765) 674-7889
Entity
Organization
Contact information
Practice address
925 E MAIN ST, GAS CITY, IN 46933-1550
(765) 674-7889
Mailing address
PO BOX 1889, MUNCIE, IN 47308-1889
(765) 284-0493
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
NULL
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
05/12/2020
Last updated
05/12/2020
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