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General NPI Number Information
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NPI Number | 1689698946
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Entity Type | Individual
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Provider Name | SUZZANE MARIE BLAKE MD
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Gender | Female
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 08/01/2012
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Provider Practice Location Address
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Address Line | 4188 NW LOOP
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City | CARTHAGE
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State | TX
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Zip | 75633-2255
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Country | US
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Telephone | 903-315-4160
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Fax | 903-690-0801
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Provider Business Mailing Address
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Address Line | 4188 NW LOOP
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City | CARTHAGE
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State | TX
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Zip | 75633-2255
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Country | US
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Telephone | 903-315-4160
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Fax | 903-690-0801
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | J9976
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License Number State | TX
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