Healthcare Provider Details

I. General information

NPI: 1720176381
Provider Name (Legal Business Name): JAMES STEVEN BLAKE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 01/20/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W 40TH AVE STE 7B
PINE BLUFF AR
71603-6964
US

IV. Provider business mailing address

1801 W 40TH AVE STE 7B
PINE BLUFF AR
71603-6964
US

V. Phone/Fax

Practice location:
  • Phone: 870-541-7201
  • Fax: 870-541-7202
Mailing address:
  • Phone: 870-541-7201
  • Fax: 870-541-7202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberE-19961
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS007404E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: