MEDICARE: W. PRESTON 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
1	207X00000X	Orthopaedic Surgery Physician	ME36563	FL

General Provider Information

NPI Number	:	1912903873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	W. PRESTON BLAKE M.D.

Provider Business Mailing Address
First Line	:	2605 NW 26TH PL
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32605-2882
Country	:	US
Telephone Number	:	352-317-8230
Fax Number	:

Provider Business Practice Location Address
First Line	:	4500 W NEWBERRY RD
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32607-2245
Country	:	US
Telephone Number	:	352-336-6000
Fax Number	:	352-336-6029

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	08/02/2013

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Directions to “ W. PRESTON BLAKE M.D.” Practice Location

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