Thomas B Blake III MD PA

NPI #1477857670 in Maitland, Florida

Provider Information

NPI Number: 1477857670
Entity Type: Organization
Organization Name: Thomas B Blake III MD PA
Primary Specialty: Colon & Rectal Surgery
Enumeration Date: Jan 3, 2011
Last Updated: Jan 3, 2011

Practice Location

Address: 331 N MAITLAND AVE
Address 2: STE A-2
City: Maitland
State: Florida
ZIP Code: 32751-4762
Phone: (407) 629-5141

Authorized Official

Name: THOMAS B BLAKE III, MD
Title: OWNER/OFFICER
Phone: (407) 629-5141

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Colon & Rectal Surgery	208C00000X	Primary

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