Wendell O Blake MD PA

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

ME0016779 Issued in FL

Legal business name

WENDELL O BLAKE MD PA

Practice address

505 Martin Luther King Jr Avenue
Suite 2
Lakeland, FL 33815-1527

Phone

(863) 683-5567

Fax

(863) 686-5814

NPI assigned

Oct 3, 2013

Organization subpart

No

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

Authorized official

Name

Wendell O Blake, M.D.

Title

President

Phone

(863) 683-5567

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1380758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380758400000",
    "number": "1700213972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 MARTIN LUTHER KING JR AVENUE",
            "address_2": "SUITE 2",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338151527",
            "telephone_number": "863-683-5567",
            "fax_number": "863-686-5814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 MARTIN LUTHER KING JR AVENUE",
            "address_2": "SUITE 2",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338151527",
            "telephone_number": "863-683-5567",
            "fax_number": "863-686-5814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WENDELL O BLAKE MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-03",
        "last_updated": "2013-10-03",
        "status": "A",
        "authorized_official_last_name": "BLAKE",
        "authorized_official_first_name": "WENDELL",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "863-683-5567",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "FL",
            "license": "ME0016779",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Allan G Wells, MD
• Hayley Wells, PTA
• L'Shantey Wells, PHARM.D.
• Samantha Welmaker
• Delaney Welter
• Amanda Lyn Wendle, LMHC
• Paula P Wengerski, PA-C
• Madelyn Elizabeth Wengyn, OTD
• Ronald Edward Wentworth II
• Matthew B Werd, DPM

• General Practice Physician in Lakeland, FL
• Providers in Lakeland, FL by specialty
• General Practice Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2013; 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.