Organization
LAKE JACKSON UROLOGY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PHILMORE BLAKE (PRESIDENT)
(979) 297-9488
Entity
Organization
Contact information
Practice address
188 ABNER JACKSON PKWY, LAKE JACKSON, TX 77566-5160
(979) 297-9488
(979) 297-9185
Mailing address
188 ABNER JACKSON PKWY, LAKE JACKSON, TX 77566-5160
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Enumeration date
09/26/2006
Last updated
08/22/2020
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