Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 18069 | OK |
N | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 18069 | OK |
NPI | 1003886466 |
---|---|
Provider Name | Christine Faith Blake |
First Address | Tulsa, OK 74136-3361 |
Second Address | Tulsa, OK 74136-8307 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2006 |
Last Update Date | 06/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G11110 | (02) |