Jon Kevin Blake MD
General Practice in Gas City, IN. Organization (NPI-2).
NPI number1215559331
StatusActive
Last updated in NPPESMay 12, 2020
Details
- NPI
- 1215559331
- Entity type
- Organization (NPI-2)
- Legal business name
- Jon Kevin Blake MD
- Organization subpart
- No
- Enumeration date
- May 12, 2020
- Certification date
- May 12, 2020
- Last updated
- May 12, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208D00000X | General Practice | – | – | Yes |
Other names
- Jon K. Blake MD (Doing Business As)
Practice location
925 E Main StGas City, IN 46933-1550
Phone 765-674-7889
Mailing address
Po Box 1889Muncie, IN 47308-1889
Phone 765-284-0493
Authorized official
Jon Blake
Authorized Official/Physician
7656747889
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