Blake, Stephen David
Blake, Stephen David is an individual health care provider with primary practice located at 249 N Grove Medical Park Dr Ste 100 , Spartanburg SC 29303-4227. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Developmental – Behavioral Pediatrics, Allopathic & Osteopathic Physicians / Pediatrics. Allopathic & Osteopathic Physicians / Pediatrics is his primary health care specialty. Blake, Stephen David can be contacted via phone (864) 582-8135.Contact Information
Primary practice address
249 N Grove Medical Park Dr Ste 100
Spartanburg SC 29303-4227
Phone: (864) 582-8135
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Developmental – Behavioral Pediatrics | 2080P0006X | 26859 | South Carolina |
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 26859 | South Carolina |
Profile Details
| NPI number | 1538111588 |
|---|---|
| LBN Legal business name | Blake, Stephen David |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 17th, 2006 |
| Last updated | Mar 29th, 2023 - about 2 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1538111588 | NPPES |
| South Carolina | MEDICAID | 268597 |
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