Individual
BLAKE A SPAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
920 CHURCH ST N, CONCORD, NC 28025-2927
(704) 403-1331
(704) 403-2533
Mailing address
920 CHURCH ST N, CONCORD, NC 28025-2927
(704) 403-1331
(704) 403-2533
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
9800704
NC
207RP1001X
Pulmonary Disease Physician
Primary
9800704
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1053H
BCBS ALL PLANS
NC
01
—
1281816
UNITED HEALTHCARE
—
01
—
200322
MEDCOST
—
05
—
791053H
—
NC
01
—
9840261
CIGNA HEALTHCARE
—
Enumeration date
08/19/2006
Last updated
01/24/2022
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