Individual
LLOYD W. BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2347 E GALA ST, MERIDIAN, ID 83642-4881
(208) 323-3767
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
M11127
ID
207RP1001X
Pulmonary Disease Physician
Primary
M11127
ID
207RS0012X
Sleep Medicine (Internal Medicine) Physician
M11127
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
13251
—
ND
01
—
P00137593
RR MEDICARE
ND
Enumeration date
10/30/2006
Last updated
04/04/2017
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