DR. PERTH AGUSTA BLAKE, M.D. - NPI NUMBER 1063505105
Provider Name: DR. PERTH AGUSTA BLAKE, M.D.
NPI Number: 1063505105
Clasification: Family Medicine (207Q00000X)
Organization: YOU AND YOUR HEALTH FAMILY CARE INC
1840 CLASSIQUE LN
Phone Number: (352) 508-5046
DR. Perth Agusta Blake, M.D. is a family physician in Tavares, FL with 21 years of experience. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. The assigned NPI number for this provider is 1063505105 and is registered as an individual entity type.
The NPPES NPI record indicates the provider is a male.
Medical School: LOMA LINDA UNIVERSITY SCHOOL OF MEDICINE
Graduation Year: 1993
The provider's business address is:
1840 CLASSIQUE LN
Phone: (352) 508-5046
Fax: (352) 508-5048
The enumeration date for this NPI number is 10/2/2006 and was last updated on 3/16/2012.
Map - Location of Practice
||ASSOCIATED INPATIENT SERVICES, INC.
||GEORGE RAYMOND IKELER, M.D.
||MARGARITA DELGADO, DO
||OMNI FAMILY MEDICINE, LLC
Family Medicine (Adult Medicine)
||DR. FELIPE COLLAZO-PAGAN, M.D.
Family Medicine (Geriatric Medicine)
||SHARON NICKELL-OLM M D FAMILY MEDICAL CENTER, LLC
||DR. ZABUNISSA VYAS, M.D
The following information regarding the scope of practice of this provider is available:
Other (Legacy) Identifiers
The following legacy identifiers are available for this provider:
||Entity Type Code
||Provider Last Name Legal Name
||Provider First Name
||Provider Middle Name
||Provider Name Prefix Text
||Provider Credential Text
||Provider First Line Business Practice Location Address
||1840 CLASSIQUE LN
||Provider Business Practice Location Address City Name
||Provider Business Practice Location Address State Name
||Provider Business Practice Location Address Postal Code
||Provider Business Practice Location Address Country Code If outside U S
||Provider Business Practice Location Address Telephone Number
||Provider Business Practice Location Address Fax Number
||Provider Enumeration Date
||Last Update Date
||Provider Gender Code
||Healthcare Provider Taxonomy Code 1
||Provider License Number 1
||Provider License Number State Code 1
||Healthcare Provider Primary Taxonomy Switch 1
||Other Provider Identifier 1
||Other Provider Identifier Type Code 1
||Other Provider Identifier State 1
||Other Provider Identifier 2
||Other Provider Identifier Type Code 2
||Other Provider Identifier State 2
||Other Provider Identifier Issuer 2
||Other Provider Identifier 3
||Other Provider Identifier Type Code 3
||Other Provider Identifier State 3
||Is Sole Proprietor
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This page was last updated on: 11/14/2014
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