Individual
BLAKE THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1340 S 18TH ST STE 204, FERNANDINA BEACH, FL 32034-4733
(904) 398-7205
(904) 277-7054
Mailing address
4800 BELFORT RD, JACKSONVILLE, FL 32256-6004
(904) 398-3385
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
ME167699
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
122460200
—
FL
Enumeration date
03/27/2018
Last updated
06/03/2024
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