Dr. Roger Alan Blake, M.D.
Surgery, Surgical Critical Care in Cleveland, MS. Individual provider (NPI-1).
NPI number1023049335
StatusActive
Last updated in NPPESMar 4, 2024
Details
- NPI
- 1023049335
- Entity type
- Individual (NPI-1)
- Name
- Dr. Roger Alan Blake
- Credential
- M.D.
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Jul 5, 2006
- Certification date
- Mar 4, 2024
- Last updated
- Mar 4, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2086S0102X | Surgery, Surgical Critical Care | MC-2670 | ID | Yes |
| 174400000X | Specialist | 16881 | MS |
Practice location
907 E Sunflower Rd101
Cleveland, MS 38732-2830
Phone 662-846-8880 · Fax 662-846-8886
Mailing address
907 E Sunflower Rd101
Cleveland, MS 38732-2830
Phone 662-846-8880 · Fax 662-846-8886
Other practice locations
999 N Curtis Rd Ste 415
Boise, ID 83706-1334
Boise, ID 83706-1334
Phone 208-302-2600 · Fax 208-302-2625
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