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Organization

THOMAS B BLAKE III MD PA

Active
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Organization

THOMAS B BLAKE III MD PA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
THOMAS B BLAKE III MD (OWNER/OFFICER)
(407) 629-5141
Entity
Organization

Contact information

Practice address
331 N MAITLAND AVE, STE A-2, MAITLAND, FL 32751-4762
(407) 629-5141
(407) 629-5858
Mailing address
331 N MAITLAND AVE, STE A-2, MAITLAND, FL 32751-4762
(407) 629-5141
(407) 629-5858

Taxonomy

Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary

Other

Enumeration date
01/03/2011
Last updated
01/03/2011
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