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NPI Code Detail

MEDICARE: DR. BRETT PATRICK BLAKE M.D.

MEDICARE: DR. BRETT PATRICK BLAKE M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207N00000XDermatology PhysicianME125767FL
2207ND0101XMOHS-Micrographic Surgery PhysicianME125767FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1376772707
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRETT PATRICK BLAKE M.D.
Provider Business Mailing Address
First Line : 18228 N US HIGHWAY 41
Second Line :
City : LUTZ
State : FL
Zip : 33549-4400
Country : US
Telephone Number : 813-321-1786
Fax Number : 813-321-1787
Provider Business Practice Location Address
First Line : 525 N DACIE PT
Second Line :
City : LECANTO
State : FL
Zip : 34461-8399
Country : US
Telephone Number : 813-321-1786
Fax Number : 813-321-1787
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2009
Last Update Date : 12/03/2025

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