Paul A Blake IV, DO (AS OF 5/31/2020)
Individual provider Active NPI Aerospace Medicine Physician · Little Rock Afb, AR
NPI 1639799158 · NPPES record last updated Oct 1, 2021
Key facts
- NPI
- 1639799158
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Aerospace Medicine Physician 2083A0100X
- License
- 2470 (NE)
- Practice address
- 1090 Arnold Dr
Little Rock Afb, AR 72099-4933 - Phone
- (501) 987-7319
- NPI assigned
- Apr 24, 2020
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20211020002136 | AR | Order and Referring Only - General Practice |
4183012396 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Aerospace Medicine Physician | 2083A0100X | 2470 | NE | Yes |
Addresses
Primary practice location
1090 Arnold Dr
Little Rock Afb, AR 72099-4933
Mailing address
1090 Arnold Dr
Little Rock Afb, AR 72099-4933
Phone (501) 987-7319
Other providers in Little Rock Afb, AR
- Rondre Florant Baluyot
- Breanna Banks
- Tommy Nelson Belcher
- Roger Lafe Benjamin
- Lisa R Blackman
- Shyanne J. Bredman
- Paula Jean Bridges
- Arnetha La'Tres Brooks
- James Steven Bryant
- Michael Burnett
All providers in Little Rock Afb, AR · Aerospace Medicine Physician in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 1, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.