Provider Demographics
NPI:1265964803
Name:BLAKE, KURT EDSON GEORGE (MD)
Entity type:Individual
Prefix:DR
First Name:KURT
Middle Name:EDSON GEORGE
Last Name:BLAKE
Suffix:
Gender:
Credentials:MD
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Mailing Address - Street 1:2015 2ND AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-7889
Mailing Address - Country:US
Mailing Address - Phone:843-793-6980
Mailing Address - Fax:
Practice Address - Street 1:4902 VALLEYDALE RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-4613
Practice Address - Country:US
Practice Address - Phone:205-677-5454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-02
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.41045207RR0500X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology