Individual
MR. BLAKE ALEXANDER MATTOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1 MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2011
Mailing address
3909 PALLAS WAY APT 3F, HIGH POINT, NC 27265-3631
(336) 409-4310
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-09476
NC
363AM0700X
Medical Physician Assistant
0010-09476
NC
Other
Enumeration date
09/18/2019
Last updated
09/24/2019
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