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Organization
TAKE AIM PSYCHOTHERAPY
Active
Organization
TAKE AIM PSYCHOTHERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WAYNE S BLAKE DO (OWNER)
(941) 387-4070
Entity
Organization
Contact information
Practice address
741 S BENEVA RD, SARASOTA, FL 34232-2411
(941) 387-4070
(941) 922-4742
Mailing address
PO BOX 15342, SARASOTA, FL 34277-1342
(941) 387-4070
(941) 922-4742
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
OS10255
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
280257100
—
FL
01
—
OS10255
STATE MEDICAL LICENSE
FL
Enumeration date
06/09/2017
Last updated
06/09/2017
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