Individual
JEFFREY W BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1620 NECTARINE ST, FERNANDINA BEACH, FL 32034-4724
(904) 548-1860
(904) 277-7283
Mailing address
PO BOX 517, FERNANDINA BEACH, FL 32035-0517
(904) 548-1800
(904) 277-7286
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
LL478
FL
Other
Enumeration date
08/07/2006
Last updated
07/08/2007
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