Individual
JEFFREY BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
317 MARTIN LUTHER KING JR WAY, TACOMA, WA 98405-4234
(253) 403-1418
Mailing address
315 MARTIN LUTHER KING JR WAY, TACOMA, WA 98405-4234
(253) 403-1418
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD00044860
WA
Other
Enumeration date
07/18/2006
Last updated
09/08/2010
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