Individual
BLAKE ELIZABETH GREGORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1411 E 31ST ST, OAKLAND, CA 94602-1018
(214) 537-8323
Mailing address
15400 FOOTHILL BLVD, ALAMEDA HEALTH SYSTEM, SAN LEANDRO, CA 94578-1009
(214) 537-8323
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
A119282
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CA120442
MEDICARE PTAN
CA
Enumeration date
05/11/2010
Last updated
08/15/2014
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