Blake, Kendall T

Blake, Kendall T is an individual health care provider with primary practice located at 2500 N State St Dept Of Orthopedics, Jackson MS 39216-4500. He recently has only one registered license in Allopathic & Osteopathic Physicians / Orthopaedic Surgery of the Spine, which is considered as his primary health care specialty. Blake, Kendall T can be contacted via phone (601) 984-6525.

Contact Information

Primary practice address
2500 N State St Dept Of Orthopedics Jackson MS 39216-4500
Phone: (601) 984-6525
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Orthopaedic Surgery of the Spine 207XS0117X 06797 Mississippi

Profile Details

NPI number 1427072966
LBN Legal business name Blake, Kendall T
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 27th, 2006
Last updated Mar 7th, 2014 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1427072966 NPPES
Mississippi MEDICAID 00116141

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