# TJ MEDICAL LLC

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

## Provider details

- **NPI number:** 1861788036
- **Authorized official:** MR. PETER BLAKE (OWNER)
- **Authorized official phone:** (772) 467-9083

## Contact information

- **Practice address:** 1905 S 25TH ST, SUITE 100, FORT PIERCE, FL 34947-4739
- **Practice address phone:** (772) 467-9083
- **Mailing address:** 1905 S 25TH ST, SUITE 100, FORT PIERCE, FL 34947-4739
- **Mailing address phone:** (772) 467-9083

## Taxonomy

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

## Other

- **Enumeration date:** 06/25/2011
- **Last updated:** 06/25/2011