Individual
BLAKE THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
350 S 40TH ST, MUSKOGEE, OK 74401-4915
(918) 910-4300
(918) 910-4315
Mailing address
815 MAIN ST STE C, PEORIA, IL 61602-1080
(309) 672-4977
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
036171685
IL
207Q00000X
Family Medicine Physician
Primary
9323
OK
390200000X
Student in an Organized Health Care Education/Training Program
90200000X
IL
Other
Enumeration date
04/25/2022
Last updated
11/17/2025
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