Individual
DR. ROGER ALAN BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
907 E SUNFLOWER RD, 101, CLEVELAND, MS 38732-2830
(662) 846-8880
(662) 846-8886
Mailing address
907 E SUNFLOWER RD, 101, CLEVELAND, MS 38732-2830
(662) 846-8880
(662) 846-8886
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
16881
MS
2086S0102X
Surgical Critical Care Physician
Primary
MC-2670
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00122620
—
MS
01
—
7887026
AETNA
—
Enumeration date
07/05/2006
Last updated
03/04/2024
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