Individual
STEPHEN DAVID BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2400 GREATSTONE PT FL 2, LEXINGTON, KY 40504-3274
(859) 323-6211
(859) 257-7706
Mailing address
2400 GREATSTONE PT FL 2, LEXINGTON, KY 40504-3274
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
26859
SC
208000000X
Pediatrics Physician
Primary
37617
KY
2080P0006X
Developmental - Behavioral Pediatrics Physician
26859
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
268597
—
SC
Enumeration date
05/17/2006
Last updated
10/29/2025
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