Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | MD192627 | OR |
N | 207XS0106X | Orthopaedic Hand Surgeon | 8585 | MT |
Y | 2086S0105X | Surgery of the Hand | 8585 | MT |
NPI | 1285635904 |
---|---|
Provider Name | Dr. Robert B Blake |
First Address | Bozeman, MT 59715-8812 |
Second Address | Bozeman, MT 59715-8812 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2005 |
Last Update Date | 05/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
14263 | (05) | MT |
F58742 | (02) | MT |