Individual
DR. JOHNATHON BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., M.H.S.A.
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
04-42530
KS
208100000X
Physical Medicine & Rehabilitation Physician
2019034662
MO
Other
Enumeration date
04/09/2015
Last updated
06/29/2026
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