Individual
DR. MICHAEL CLARENCE BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2790 GODWIN BLVD, STE 305, SUFFOLK, VA 23434-8151
(757) 934-4222
(757) 934-4111
Mailing address
2790 GODWIN BLVD, STE 305, SUFFOLK, VA 23434-8151
(757) 934-4222
(757) 934-4111
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
0101023774
VA
Other
Enumeration date
04/05/2006
Last updated
11/13/2012
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