Individual
DR. MARTIN CALVIN BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
211 SAINT FRANCIS DR, CAPE GIRARDEAU, MO 63703-5049
(573) 331-5110
(573) 335-4689
Mailing address
PO BOX 801143, KANSAS CITY, MO 64180-1143
(573) 331-3000
(573) 331-5073
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
2017041021
MO
207P00000X
Emergency Medicine Physician
39115
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/17/2013
Last updated
03/10/2021
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