Individual
BLAKE T GREENFIELD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2900 DOOLITTLE DR, ELLSWORTH AFB, SD 57706
(605) 385-3111
Mailing address
2900 DOOLITTLE DR, ELLSWORTH AFB, SD 57706-4821
(605) 385-3208
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0553
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0553
LICENSE PHYSICIAN ASSISTANT
SD
01
—
1058388
NCCPA CERT
SD
Enumeration date
06/03/2006
Last updated
01/17/2025
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