Organization
DAVID A. BLAKE M.D. INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID ALLEN BLAKE M.D. (PRESIDENT)
(626) 818-5077
Entity
Organization
Contact information
Practice address
225 S LAKE AVE, SUITE 225, PASADENA, CA 91101-3005
(626) 795-6596
(626) 396-0851
Mailing address
225 S LAKE AVE, 535, PASADENA, CA 91101-3005
(626) 795-6596
(626) 795-8247
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A770880
—
CA
01
—
W21510
MEDICARE GROUP PTAN
CA
Enumeration date
08/05/2006
Last updated
09/11/2008
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