Individual
ROBERT B BLAKE
Active
Individual
ROBERT B BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2084E0001X
Epilepsy Physician
01078434A
IN
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
01078434A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001098706
ANTHEM PTAN
IN
05
—
300002988
—
IN
Enumeration date
04/11/2011
Last updated
03/03/2025
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