Gerald Wayne Blake, M.D.
Individual provider Active NPI Internal Medicine Physician · Sanford, NC
NPI 1063743979 · NPPES record last updated Jan 18, 2010
Key facts
- NPI
- 1063743979
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 15438 (NC)
- Practice address
- 1139 Carthage St
Suite 110
Sanford, NC 27330-4111 - Phone
- (919) 774-2195
- Fax
- (919) 776-8131
- NPI assigned
- Jan 18, 2010
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rex Hospital, Inc. | Past | Accepting new patients | |
| Wakemed | Past |
Accepting new patients | |
| Wakemed | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 15438 | NC | Yes |
Addresses
Primary practice location
1139 Carthage St
Suite 110
Sanford, NC 27330-4111
Mailing address
1139 Carthage St
Suite 110
Sanford, NC 27330-4111
Phone (919) 774-2195
Other providers in Sanford, NC
- Krishna Prasad Bhat
- Bethany Frye Bibey
- Claire Elizabeth Biddix
- Robin Dawn Bilodeau
- Martha Blair Pinion Bischof
- Elizabeth Bleyl
- Bloom Counseling of Sanford
- Vladim Bobrovnikov
- Brianna Marie Boffoli
- Ashley G. Boles
All providers in Sanford, NC · Internal Medicine Physician in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 18, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.