Individual
DR. THOMAS HAROLD BLAKE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
424 S 13TH AVE, LAUREL, MS 39440-4345
(601) 399-6167
(601) 399-6281
Mailing address
424 SOUTH 12TH AVE, LAUREL, MS 39440
(601) 399-6167
(601) 399-6281
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
07473
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00015289
—
MS
Enumeration date
03/14/2006
Last updated
02/13/2014
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