| Doctor Name: | ALEX BLAKE |
| NPI Number: | 1710348701 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CSFA |
| License Number: | 157559 |
| Business Practice Address: | 10743 S State Route 133 Blanchester, OH - 451079435 |
| Business Phone Number: | 9377289782 |
| Business Fax Number: | |
| Mailing Address: | 7777 Yankee Rd, LIBERTY TOWNSHIP |
| State: | OH |
| Postal Code: | 450443500 |
| Phone Number: | 5138039600 |
| Fax Number: | |
| NPI Enumeration Date: | 03/17/2016 |
| NPI Last Update Date: | 03/17/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AS0400X |
| License Number: | 157559 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Surgical |
| Taxonomy Definition: | |