Healthcare Provider Details

I. General information

NPI: 1174671820
Provider Name (Legal Business Name): GEORGE E. BLAKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 SOUTH WOODS MILL ROAD SUITE 500 NORTH
CHESTERFIELD MO
63017
US

IV. Provider business mailing address

222 S WOODS MILL RD
CHESTERFIELD MO
63017-3625
US

V. Phone/Fax

Practice location:
  • Phone: 314-205-6699
  • Fax: 314-590-5923
Mailing address:
  • Phone: 314-205-6699
  • Fax: 314-590-5923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number2023006705
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: