BLAKE FAMILY MEDICINE PLLC
Organization (NPI-2)
Active
Family Medicine
Provider Information
- NPI Number
1295959310- Provider Type
- Organization / Facility (NPI-2)
- Status
- Active
Contact & Location
- Address
- 4704 MAIN ST, SHALLOTTE, NC, 284701880
- Phone
- (910) 754-4545
- Fax
- (910) 754-4794
Specialties & Taxonomies
Physician Assistant
License: NC #103290
Physician Assistant
License: NC #103296
Family Medicine
Primary License: NC #10868