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NPI Code Detail

MEDICARE: WILLIAM EDWARD BLAKE MD

MEDICARE: WILLIAM EDWARD BLAKE MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician011575LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1144224817
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLIAM EDWARD BLAKE MD
Provider Business Mailing Address
First Line : 298 HENRY CLAY AVE
Second Line :
City : NEW ORLEANS
State : LA
Zip : 70118-5720
Country : US
Telephone Number : 504-896-9827
Fax Number : 504-894-5370
Provider Business Practice Location Address
First Line : 4740 S I 10 SERVICE RD W
Second Line :
City : METAIRIE
State : LA
Zip : 70001-1234
Country : US
Telephone Number : 504-883-3703
Fax Number : 504-883-3704
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2005
Last Update Date : 02/02/2011

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Directions to “ WILLIAM EDWARD BLAKE MD” Practice Location

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