Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | MD9418 | TN |
NPI | 1033169305 |
---|---|
Provider Name | Dr. William Woods Blake |
First Address | Soddy Daisy, TN 37379-3607 |
Second Address | Chattanooga, TN 37403-2103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F32246 | (02) | TN |