Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 35130836 | OH |
N | 207RC0000X | Internist - Cardiovascular Disease | 01068537A | IN |
Y | 207RC0000X | Internist - Cardiovascular Disease | 35130836 | OH |
NPI | 1174671820 |
---|---|
Provider Name | George E. Blake |
First Address | Cincinnati, OH 45236-6704 |
Second Address | Cincinnati, OH 45236 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 20/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200992360 | (05) | IN |
HQ800Z | PTAN (01) | FL |