Healthcare Provider Details

I. General information

NPI: 1609050566
Provider Name (Legal Business Name): C CURTIS BLAKE M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 12/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MT HIGHWAY 91 S STE 206
DILLON MT
59725-3535
US

IV. Provider business mailing address

30 MT HIGHWAY 91 S STE 206
DILLON MT
59725-3535
US

V. Phone/Fax

Practice location:
  • Phone: 406-683-4252
  • Fax:
Mailing address:
  • Phone: 406-683-4252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: C CURTIS BLAKE
Title or Position: OWNER
Credential:
Phone: 406-683-4252