Individual
PHILMORE BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
188 ABNER JACKSON PKWY, LAKE JACKSON, TX 77566-5160
(979) 297-9488
(979) 297-9185
Mailing address
188 ABNER JACKSON PKWY, LAKE JACKSON, TX 77566-5160
(979) 297-9488
(979) 297-9185
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
K7246
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0315798-01
—
TX
Enumeration date
07/11/2006
Last updated
03/26/2015
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