Individual
BLAKE OLMSTED
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6414 U S HIGHWAY 98 STE 80, HATTIESBURG, MS 39402-7838
(601) 261-1800
(601) 261-1801
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 579-5463
(601) 261-1801
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
23912
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05583609
—
MS
Enumeration date
06/29/2012
Last updated
08/11/2020
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