Individual
DR. JEFFREY M BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
14540 PRAIRIE LAKES BLVD N STE 110, NOBLESVILLE, IN 46060-4370
(317) 982-5222
(317) 982-5223
Mailing address
14540 PRAIRIE LAKES BLVD N STE 110, NOBLESVILLE, IN 46060-4370
(317) 982-5222
(317) 982-5223
Taxonomy
Speciality
Code
Description
License number
State
207VF0040X
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
Primary
01040057A
IN
207VG0400X
Gynecology Physician
01040057A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100172960
—
IN
05
—
300085297
—
IN
Enumeration date
08/18/2005
Last updated
11/14/2024
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