MEDICARE: PHILMORE BLAKE

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
1	208800000X	Urology Physician	K7246	TX

Other Identifiers

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

General Provider Information

NPI Number	:	1316972458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILMORE BLAKE

Provider Business Mailing Address
First Line	:	188 ABNER JACKSON PKWY
Second Line	:
City	:	LAKE JACKSON
State	:	TX
Zip	:	77566-5160
Country	:	US
Telephone Number	:	979-297-9488
Fax Number	:	979-297-9185

Provider Business Practice Location Address
First Line	:	188 ABNER JACKSON PKWY
Second Line	:
City	:	LAKE JACKSON
State	:	TX
Zip	:	77566-5160
Country	:	US
Telephone Number	:	979-297-9488
Fax Number	:	979-297-9185

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	03/26/2015

Similar Medicare Providers

1831162262 — DR. GREGORY PAUL PISARSKI MD
Practice Location Address:

186 ABNER JACKSON PKWY
LAKE JACKSON, TX
77566-5160

Practice Phone: 979-297-9289
Practice Fax: 979-299-1007

1316928021 — RAJESH V DALAL MD
Practice Location Address:

192 ABNER JACKSON PKWY
LAKE JACKSON, TX
77566-5160

Practice Phone: 979-285-0007
Practice Fax: 979-256-0930

1255391827 — COMMUNITY HOSPITAL OF BRAZOSPORT
Practice Location Address:

194 ABNER JACKSON PARKWAY
LAKE JACKSON, TX
77566-5160

Practice Phone: 979-299-3236
Practice Fax: 979-299-6407

1558462812 — LAKE JACKSON UROLOGY PA
Practice Location Address:

188 ABNER JACKSON PKWY
LAKE JACKSON, TX
77566-5160

Practice Phone: 979-297-9488
Practice Fax: 979-297-9185

1093027807 — DR. FRANK EDOZE OKOSUN JR. M.D
Practice Location Address:

188 ABNER JACKSON PKWY
LAKE JACKSON, TX
77566-5160

Practice Phone: 979-266-9776
Practice Fax: 979-529-2952

1144729492 — RAJ DALAL MD PA
Practice Location Address:

192 ABNER JACKSON PKWY
LAKE JACKSON, TX
77566-5160

Practice Phone: 979-285-0007
Practice Fax: 979-529-2309

Directions to “ PHILMORE BLAKE ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.