George Blake M.D., P.a.

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

ME66396 Issued in FL

Legal business name

GEORGE BLAKE M.D., P.A.

Practice address

605 S Fremont Ave
Suite a
Tampa, FL 33606-2479

Phone

(813) 251-0209

Fax

(813) 258-0600

NPI assigned

May 31, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. George B Blake, M.D.NPI 1962449587

Title

President

Phone

(813) 251-0209

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/JEEDBA

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• George B Blake, M.D.

  • Otolaryngology Physician
  • Tampa, FL
  • NPI 1962449587
  Medicare reassignment NPD Authorized official
• Stella Blake, APRN

  • Nurse Practitioner
  • Tampa, FL
  • NPI 1417719220
  NPD (past)
• William Campbell Blake, ED.D.

  • Mental Health Counselor
  • Tampa, FL
  • NPI 1013162825
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326412800000",
    "number": "1164469151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 S FREMONT AVE",
            "address_2": "SUITE A",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336062479",
            "telephone_number": "813-251-0209",
            "fax_number": "813-258-0600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 S FREMONT AVE",
            "address_2": "SUITE A",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336062479",
            "telephone_number": "813-251-0209",
            "fax_number": "813-258-0600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGE BLAKE M.D., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-31",
        "last_updated": "2012-01-13",
        "status": "A",
        "authorized_official_last_name": "BLAKE",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "813-251-0209",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Otolaryngology",
            "state": "FL",
            "license": "ME66396",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "379713900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• George Linsey, O.D.P.a.
• George M Northrup M D P a
• George Tabib DC PA
• Carolyn George, PSY.D.

• Otolaryngology Physician in Tampa, FL
• Providers in Tampa, FL by specialty
• Otolaryngology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.