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DR. PERTH AGUSTA BLAKE M.D. NPI 1063505105

NPI Profile

NPI: 1063505105

Provider Name: DR. PERTH AGUSTA BLAKE, M.D.

Classification: Family Medicine - 207Q00000X

Entity Type: Individual

Organization: YOU AND YOUR HEALTH FAMILY CARE INC

PECOS Registration: Yes

Address:
1840 CLASSIQUE LN
TAVARES, FL
ZIP 32778

Phone: (352) 508-5046

DR. Perth Agusta Blake, M.D. is a family physician in Tavares, FL with 22 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. DR. Perth Agusta Blake, M.D. NPI is 1063505105. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: LOMA LINDA UNIVERSITY SCHOOL OF MEDICINE
Graduation Year:1993

The provider's business location address is:

1840 CLASSIQUE LN
TAVARES, FL
ZIP 32778-748
Phone: (352) 508-5046
Fax: (352) 508-5048

The NPI 1063505105 is registered in the Medicare Provider, Enrollment, Chain and Ownership System PECOS.

The enumeration date for this NPI number is 10/2/2006 and was last updated on 3/16/2012.

Map - Location of Practice

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 207Q00000X Family Medicine ME0069890 FLORIDA Yes

What is NPI?
NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 7/13/2015