Individual
JOHN A BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
712 VILLAGE RD SW STE 104, SHALLOTTE, NC 28470-3449
(910) 754-7607
(910) 754-7608
Mailing address
712 VILLAGE RD SW STE 104, SHALLOTTE, NC 28470-3449
(910) 754-7607
(910) 754-7608
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
103290NC
NC
Other
Enumeration date
02/12/2007
Last updated
06/03/2019
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