Healthcare Provider Details

I. General information

NPI: 1790960144
Provider Name (Legal Business Name): BLAKE EUGENE MCGEHEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2008
Last Update Date: 04/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1888 HUDSON CIR STE 2
MONROE LA
71201-3546
US

IV. Provider business mailing address

1888 HUDSON CIR STE 2
MONROE LA
71201-3546
US

V. Phone/Fax

Practice location:
  • Phone: 318-387-3453
  • Fax:
Mailing address:
  • Phone: 318-387-3453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberMD204752
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number136276
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: