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General NPI Number Information
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NPI Number | 1942411087
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Entity Type | Organization
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Legal Business Name | GEORGE J BLAKE MD PC
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5153 E 51ST ST SUITE 100
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City | TULSA
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State | OK
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Zip | 74135-7456
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Country | US
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Telephone | 918-828-0230
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Fax | 918-828-0231
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Provider Business Mailing Address
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Address Line | 5153 E 51ST ST SUITE 100
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City | TULSA
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State | OK
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Zip | 74135-7456
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Country | US
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Telephone | 918-828-0230
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Fax | 918-828-0231
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Authorized Official
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Title or Position | PHYSICIAN-OWNER
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Name | GEORGE JACOB BLAKE
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Credential | MD
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Telephone | 918-828-0230
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 18245
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License Number State | OK
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