Individual
BLAKE ANDREW MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
3801 S NATIONAL AVE STE 700, SPRINGFIELD, MO 65807-5210
(417) 885-3888
(471) 520-5959
Mailing address
1411 E PRIMROSE ST STE C, SPRINGFIELD, MO 65804-4377
(417) 882-1207
(417) 881-7268
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
2018004423
MO
Other
Enumeration date
02/21/2018
Last updated
06/22/2021
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