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NPI Code Detail

MEDICARE: BLAKE DRYER MD

MEDICARE: BLAKE DRYER 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
1208100000XPhysical Medicine & Rehabilitation Physician2023018490MO
2207R00000XInternal Medicine Physician2022023918MO

General Provider Information

NPI Number : 1225760036
Entity Type Code : Individual
Provider Name (Legal Business Name) : BLAKE DRYER MD
Provider Business Mailing Address
First Line : PO BOX 959354
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63195-9354
Country : US
Telephone Number : 314-953-8799
Fax Number : 314-953-8798
Provider Business Practice Location Address
First Line : 11155 DUNN RD STE 109N
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63136-6148
Country : US
Telephone Number : 314-953-8799
Fax Number : 314-953-8798
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2022
Last Update Date : 05/04/2026

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