Individual
DR. BLAKE L ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD PHD
Contact information
Practice address
9001 S 101ST EAST AVE STE 280, TULSA, OK 74133-5711
(918) 459-8824
Mailing address
1145 S UTICA AVE STE 110, TULSA, OK 74104-4013
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
L6260
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1459097
BEECHSTREET
TX
05
—
157856901
—
TX
Enumeration date
09/29/2005
Last updated
01/12/2021
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