Individual
SAL BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2211 MAYFAIR DR STE 102, OWENSBORO, KY 42301
(270) 688-1351
(270) 683-3420
Mailing address
PO BOX 23229, OWENSBORO, KY 42304-3229
(270) 688-1330
(270) 688-1338
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
TC733
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100552610
—
KY
Enumeration date
08/09/2018
Last updated
05/14/2019
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