Individual
ANDREA BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
4102 PINION DR, GENERAL SURGERY, USAF ACADEMY, CO 80840-2502
(719) 333-5140
(719) 333-5836
Mailing address
4102 PINION DR, GENERAL SURGERY, USAF ACADEMY, CO 80840-2502
(719) 333-5140
(719) 333-5836
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
DR0052469
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
91585783
—
CO
Enumeration date
09/28/2008
Last updated
11/21/2013
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