Individual
DR. JEREMY T. BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
264 COATSLAND DR., JACKSON, TN 38301
(731) 423-1500
(731) 423-0342
Mailing address
264 COATSLAND DR., JACKSON, TN 38301
(731) 423-1500
(731) 423-0342
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD0000031623
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5440909
—
TN
Enumeration date
10/11/2006
Last updated
10/17/2018
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