Individual
BENJAMIN BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2600 OTTAWA RD, NEODESHA, KS 66757-1897
(620) 325-2611
(620) 325-8453
Mailing address
PO BOX 360, NEODESHA, KS 66757-0360
(620) 325-2611
(620) 325-8453
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
15-02102
—
Other
Enumeration date
06/26/2018
Last updated
09/25/2024
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