Individual
RICHARD ALAN BLAKE
Active
Individual
RICHARD ALAN BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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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