Individual
DR. JONATHAN E. BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1401 HWY 65 NORTH SUITE 210, HARRISON, AR 72601
(870) 414-5600
(870) 414-5601
Mailing address
1401 HWY 65 NORTH SUITE 210, HARRISON, AR 72601
(870) 414-5600
(870) 414-5601
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
133417
IL
207X00000X
Orthopaedic Surgery Physician
7833
SD
207X00000X
Orthopaedic Surgery Physician
Primary
T3745
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
244982104
—
MO
05
—
6400000
—
SD
Enumeration date
02/14/2006
Last updated
08/11/2023
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