Provider Demographics
NPI:1184785149
Name:BLAKE, JOHN PAUL I (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PAUL
Last Name:BLAKE
Suffix:I
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:PAUL
Other - Last Name:BLAKE
Other - Suffix:I
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:211 S CENTENNIAL ST
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27260-5215
Mailing Address - Country:US
Mailing Address - Phone:336-845-7946
Mailing Address - Fax:336-845-7601
Practice Address - Street 1:211 S CENTENNIAL ST
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27260-5215
Practice Address - Country:US
Practice Address - Phone:336-845-7946
Practice Address - Fax:336-845-7601
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC117952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8916172Medicaid
NC2027171Medicare PIN
NC8916172Medicaid