Individual
GERALD WAYNE BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1139 CARTHAGE ST, SUITE 110, SANFORD, NC 27330-4111
(919) 774-2195
(919) 776-8131
Mailing address
1139 CARTHAGE ST, SUITE 110, SANFORD, NC 27330-4111
(919) 774-2195
(919) 776-8131
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
15438
NC
Other
Enumeration date
01/18/2010
Last updated
01/18/2010
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