Individual
MR. PAUL A BLAKE IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO (AS OF 5/31/2020)
Contact information
Practice address
1090 ARNOLD DR, LITTLE ROCK AFB, AR 72099-4933
(501) 987-7319
Mailing address
1090 ARNOLD DR, LITTLE ROCK AFB, AR 72099-4933
(501) 987-7319
Taxonomy
Speciality
Code
Description
License number
State
2083A0100X
Aerospace Medicine Physician
Primary
2470
NE
Other
Enumeration date
04/24/2020
Last updated
10/01/2021
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