Individual
RICHARD ALAN BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1401 HARRODSBURG RD, SUITE A-300, LEXINGTON, KY 40504-3751
(859) 276-4429
(859) 276-5939
Mailing address
PO BOX 936, LONDON, KY 40743-0936
(606) 330-7840
(606) 330-7825
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
29029
KY
207RI0011X
Interventional Cardiology Physician
Primary
29029
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06003363
RR MEDICARE PIN
KY
01
—
36000818
MEDICAID ASC GROUP
KY
01
—
37903705
MEDICAID LAB GROUP
KY
01
—
4000501
MEDICARE LAB GROUP
KY
05
—
64290299
—
KY
01
—
ASC1019
MEDICARE ASC GROUP
KY
01
—
CB5773
RR MEDICARE GROUP
KY
Enumeration date
06/27/2006
Last updated
05/06/2019
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