Provider Demographics
NPI:1841257482
Name:BLAKE, GREGORY HAROLD (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:HAROLD
Last Name:BLAKE
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
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Mailing Address - Street 1:1924 ALCOA HWY
Mailing Address - Street 2:U-67
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1511
Mailing Address - Country:US
Mailing Address - Phone:865-544-9352
Mailing Address - Fax:865-544-9314
Practice Address - Street 1:1924 ALCOA HWY
Practice Address - Street 2:U-100
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1511
Practice Address - Country:US
Practice Address - Phone:865-544-9351
Practice Address - Fax:865-544-9314
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2012-09-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN26558207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3092066Medicaid
TN3523237OtherCIGNA
TN100011282OtherPHP TENNCARE
TN5766020OtherAETNA
TN01-41085OtherUNITED HEATLH CARE
080100419OtherRAILROAD MEDICARE
TN1689631137OtherGROUP NPI
TN3023731OtherBLUE CROSS/BLUE SHIELD
TNTN0191OtherJOHN DEERE
080100419OtherRAILROAD MEDICARE
TN3023731OtherBLUE CROSS/BLUE SHIELD