Healthcare Provider Details

I. General information

NPI: 1962529099
Provider Name (Legal Business Name): DANIEL BLAKE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 TABERNACLE RD
BLACK MOUNTAIN NC
28711-2526
US

IV. Provider business mailing address

102 TACOMA CIR
ASHEVILLE NC
28801-1626
US

V. Phone/Fax

Practice location:
  • Phone: 828-669-3480
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number23830
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: