# JON KEVIN BLAKE MD

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Jon K. Blake MD
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215559331
- **Authorized official:** JON BLAKE MD (AUTHORIZED OFFICIAL/PHYSICIAN)
- **Authorized official phone:** (765) 674-7889

## Contact information

- **Practice address:** 925 E MAIN ST, GAS CITY, IN 46933-1550
- **Practice address phone:** (765) 674-7889
- **Mailing address:** PO BOX 1889, MUNCIE, IN 47308-1889
- **Mailing address phone:** (765) 284-0493

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/12/2020
- **Last updated:** 05/12/2020