Jon Kevin Blake MD

NPI #1215559331 in Gas City, Indiana

Provider Information

NPI Number
1215559331
Entity Type
Organization
Organization Name
Jon Kevin Blake MD
Primary Specialty
General Practice
Enumeration Date
May 12, 2020
Last Updated
May 12, 2020

Practice Location

Address
925 E MAIN ST
State
Indiana
ZIP Code
46933-1550
Phone
(765) 674-7889

Authorized Official

Name
JON BLAKE, MD
Title
AUTHORIZED OFFICIAL/PHYSICIAN
Phone
(765) 674-7889

Specialties & Taxonomy Codes

Specialty
General Practice

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