Blake, Perth Agusta

Blake, Perth Agusta is an sole proprietor health care provider with primary practice located at 1840 Classique Ln , Tavares FL 32778-5748. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Blake, Perth Agusta can be contacted via phone (352) 508-5046.

Contact Information

Primary practice address
1840 Classique Ln Tavares FL 32778-5748
Phone: (352) 508-5046
Fax: (352) 508-5048
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X ME0069890 Florida

Profile Details

NPI number 1063505105
LBN Legal business name Blake, Perth Agusta
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 2nd, 2006
Last updated Mar 16th, 2012 - about 14 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 1063505105 NPPES
Florida Other 31711Y MEDICARE ID
Florida MEDICAID 255623500 MEDICARE ID

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