Healthcare Provider Details

I. General information

NPI: 1750624961
Provider Name (Legal Business Name): ERIN ALISON BLAKE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2013
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7130 N MILLBROOK AVE
FRESNO CA
93720-3347
US

IV. Provider business mailing address

104 WOODMONT BLVD STE 500
NASHVILLE TN
37205-2245
US

V. Phone/Fax

Practice location:
  • Phone: 559-326-1222
  • Fax:
Mailing address:
  • Phone: 714-461-9016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberMD2020-0588
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberA148612
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: