NPIMap

Organization Active NPI

Thomas B Blake III MD PA

  • Colon & Rectal Surgery Physician
  • Maitland, FL
National Provider Identifier
1477857670
Registry record updated Jan 3, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Colon & Rectal Surgery PhysicianTaxonomy code 208C00000X
Legal business name
THOMAS B BLAKE III MD PA
Practice address
331 N Maitland Ave
Ste a-2
Maitland, FL 32751-4762
Phone
(407) 629-5141
Fax
(407) 629-5858
NPI assigned
Jan 3, 2011
Last updated
Jan 3, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2011

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

Authorized official

Name
Thomas B Blake III, MDNPI 1508873787
Title
Owner/Officer
Phone
(407) 629-5141

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Colon & Rectal Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208C00000X Primary

Addresses

Primary practice location

331 N Maitland Ave
Ste a-2
Maitland, FL 32751-4762

Mailing address

331 N Maitland Ave
Ste a-2
Maitland, FL 32751-4762
Phone (407) 629-5141

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1294012800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294012800000",
    "number": "1477857670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "331 N MAITLAND AVE",
            "address_2": "STE A-2",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327514762",
            "telephone_number": "407-629-5141",
            "fax_number": "407-629-5858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "331 N MAITLAND AVE",
            "address_2": "STE A-2",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327514762",
            "telephone_number": "407-629-5141",
            "fax_number": "407-629-5858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THOMAS B BLAKE III MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-03",
        "last_updated": "2011-01-03",
        "status": "A",
        "authorized_official_last_name": "BLAKE",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER/OFFICER",
        "authorized_official_telephone_number": "407-629-5141",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208C00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Colon & Rectal Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maitland, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.