Provider Demographics
NPI:1033169305
Name:BLAKE, WILLIAM WOODS (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:WOODS
Last Name:BLAKE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10727 GREENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SODDY DAISY
Mailing Address - State:TN
Mailing Address - Zip Code:37379-3607
Mailing Address - Country:US
Mailing Address - Phone:423-842-4289
Mailing Address - Fax:423-842-5573
Practice Address - Street 1:975 E 3RD ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2103
Practice Address - Country:US
Practice Address - Phone:423-778-6170
Practice Address - Fax:423-778-6938
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNMD94182080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNF32246Medicare UPIN