Provider Demographics
NPI:1003886466
Name:BLAKE, CHRISTINE FAITH (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:FAITH
Last Name:BLAKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:6600 S YALE AVE STE 1200
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3361
Mailing Address - Country:US
Mailing Address - Phone:918-488-6687
Mailing Address - Fax:918-488-6098
Practice Address - Street 1:6565 S YALE AVE STE 601
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-8307
Practice Address - Country:US
Practice Address - Phone:918-502-4636
Practice Address - Fax:918-502-4640
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2018-03-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK18069207VM0101X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G11110Medicare UPIN