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NPI Code Detail

MEDICARE: JASON BLAKE DO

MEDICARE: JASON BLAKE DO
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
1208M00000XHospitalist PhysicianDO2895ME
2207Q00000XFamily Medicine PhysicianDO2895ME

General Provider Information

NPI Number : 1932587722
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASON BLAKE DO
Provider Business Mailing Address
First Line : 1 MEDICAL CENTER DR
Second Line :
City : BIDDEFORD
State : ME
Zip : 04005-9422
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 300 MAIN ST
Second Line :
City : LEWISTON
State : ME
Zip : 04240-7041
Country : US
Telephone Number : 207-795-0111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2015
Last Update Date : 05/04/2026

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Directions to “ JASON BLAKE DO” Practice Location

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