Individual
MR. BLAKE MATTHEW DAVIDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1000 S LIMESTONE, LEXINGTON, KY 40536-1179
(859) 323-5901
(859) 323-3040
Mailing address
7619 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4133
(866) 413-9534
(260) 407-4428
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
55656
KY
Other
Enumeration date
03/19/2019
Last updated
05/24/2023
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