Individual
KENDALL T BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2500 N STATE ST, DEPT OF ORTHOPEDICS, JACKSON, MS 39216-4500
(601) 984-6525
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-6426
(601) 984-6439
Taxonomy
Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
06797
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00116141
—
MS
Enumeration date
07/27/2006
Last updated
03/07/2014
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