Provider Demographics
NPI:1326294208
Name:BLAKE, CAMILLE JEANETTE (DO)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:JEANETTE
Last Name:BLAKE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 MEDICAL DR.
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308
Mailing Address - Country:US
Mailing Address - Phone:850-216-0100
Mailing Address - Fax:850-309-8109
Practice Address - Street 1:1260 METROPOLITAN BLVD STE 301
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-2536
Practice Address - Country:US
Practice Address - Phone:850-216-0100
Practice Address - Fax:850-201-4818
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL1378315207R00000X
FLOS12343207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine