Individual
DR. BLAKE JERALD WILLIAMSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
14611 W 50TH ST, SHAWNEE, KS 66216-5116
(913) 248-1903
Mailing address
14611 W 50TH ST, SHAWNEE, KS 66216-5116
(913) 248-1903
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
04-23901
KS
207Q00000X
Family Medicine Physician
Primary
2003018093
MO
Other
Enumeration date
04/23/2012
Last updated
04/23/2012
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