Individual
JUDITH ELISE BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1505 DAPHNE AVE, DAPHNE, AL 36526-4298
(251) 625-2663
(251) 625-3198
Mailing address
1505 DAPHNE AVE, DAPHNE, AL 36526-4298
(251) 625-2663
(251) 625-3198
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA.1207
AL
Other
Enumeration date
02/23/2017
Last updated
10/16/2023
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