Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | D20543 | MD |
NPI | 1033149539 |
---|---|
Provider Name | Dr. James M Blake |
First Address | Annapolis, MD 21401 |
Second Address | Annapolis, MD 21401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 02/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
252031100 | (05) | MD |
D73753 | (02) | MD |