Individual
DR. BLAKE BAILEY ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2350 MIAMI VALLEY DR STE 500, CENTERVILLE, OH 45459-4780
(937) 293-1622
(937) 245-6308
Mailing address
6680 POE AVE STE 200, DAYTON, OH 45414-2855
(937) 280-8400
(937) 245-6330
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
125.059643
IL
208800000X
Urology Physician
01078386A
IN
208800000X
Urology Physician
Primary
35133214
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0292533
—
OH
Enumeration date
07/01/2011
Last updated
01/07/2022
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