| Doctor Name: | BROOKS M BLAKE |
| NPI Number: | 1164435236 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.O. |
| License Number: | L4187 |
| Business Practice Address: | 1800 Mormon Mill Rd Ste A6 Marble Falls, TX - 786544175 |
| Business Phone Number: | 8307988000 |
| Business Fax Number: | 8307988120 |
| Mailing Address: | 1800 Mormon Mill Rd, Ste A6 MARBLE FALLS |
| State: | TX |
| Postal Code: | 786544175 |
| Phone Number: | 8307988000 |
| Fax Number: | 8307988120 |
| NPI Enumeration Date: | 08/13/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 204D00000X |
| License Number: | L4187 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Neuromusculoskeletal Medicine & OMM |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |