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General NPI Number Information
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NPI Number | 1366470148
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Entity Type | Individual
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Provider Name | PAUL MAXWELL BLAKE III MD
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Gender | Male
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Dates
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Enumeration Date | 06/29/2006
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Last Update Date | 04/02/2025
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Provider Practice Location Address
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Address Line | 6201 N SUNCOAST BLVD
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City | CRYSTAL RIVER
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State | FL
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Zip | 34428-6712
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Country | US
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Telephone | 352-795-8490
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Fax | 352-795-8555
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Provider Business Mailing Address
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Address Line | PO BOX 640573
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City | BEVERLY HILLS
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State | FL
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Zip | 34464-0573
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Country | US
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Telephone | 352-795-8490
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Fax | 352-795-8555
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 20938
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME143213
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD429954
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License Number State | PA
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