Organization
GEORGE BLAKE M.D., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEORGE B BLAKE M.D. (PRESIDENT)
(813) 251-0209
Entity
Organization
Contact information
Practice address
605 S FREMONT AVE, SUITE A, TAMPA, FL 33606-2479
(813) 251-0209
(813) 258-0600
Mailing address
605 S FREMONT AVE, SUITE A, TAMPA, FL 33606-2479
(813) 251-0209
(813) 258-0600
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
ME66396
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
379713900
—
FL
Enumeration date
05/31/2006
Last updated
01/13/2012
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