Individual
JEFFREY D. BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
250 GREEN ST, GARDNER, MA 01440-1396
(978) 630-5050
(978) 630-5059
Mailing address
250 GREEN ST, GARDNER, MA 01440-1396
(978) 630-5050
(978) 630-5059
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
78308
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3118223
—
MA
Enumeration date
10/04/2005
Last updated
06/20/2011
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