Individual
BLAKE THOMAS DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 BREWSTER BLVD, CAMP LEJEUNE, NC 28547-2575
(910) 450-4357
Mailing address
USS NIMITZ, CVN68 UNIT 100103, FPO, AP 96620
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
2023-01787
NC
208600000X
Surgery Physician
ME155570
FL
Other
Enumeration date
04/13/2017
Last updated
05/13/2024
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