Healthcare Provider Details

I. General information

NPI: 1225760036
Provider Name (Legal Business Name): BLAKE DRYER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11155 DUNN RD STE 109N
SAINT LOUIS MO
63136-6148
US

IV. Provider business mailing address

PO BOX 959354
SAINT LOUIS MO
63195-9354
US

V. Phone/Fax

Practice location:
  • Phone: 314-953-8799
  • Fax: 314-953-8798
Mailing address:
  • Phone: 314-953-8799
  • Fax: 314-953-8798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2023018490
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2022023918
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: