Mr Paul A Blake Iv, DO (AS OF 5/31/2020) is a medicare enrolled "Preventive Medicine - Aerospace Medicine" physician in Little Rock Afb, Arkansas. His current practice location is
1090 Arnold Dr, Little Rock Afb, Arkansas. You can reach out to his office (for appointments etc.) via phone at
(501) 987-7319.
Mr Paul A Blake Iv is licensed to practice in Nebraska (license number 2470) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1639799158.
Physician's Profile
| Full Name | Mr Paul A Blake Iv |
|---|
| Gender | Male |
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| Speciality | Preventive Medicine - Aerospace Medicine |
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| Location | 1090 Arnold Dr, Little Rock Afb, Arkansas |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1639799158
- Provider Enumeration Date: 04/24/2020
- Last Update Date: 10/01/2021
Medicare PECOS Information:
- PECOS PAC ID: 4183012396
- Enrollment ID: I20211020002136
Medical Identifiers
Medical identifiers for Mr Paul A Blake Iv such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
| 1639799158 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
| 2083A0100X | Preventive Medicine - Aerospace Medicine | 2470 (Nebraska) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr Paul A Blake Iv is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
Mr Paul A Blake Iv, DO (AS OF 5/31/2020) 1090 Arnold Dr, Little Rock Afb, AR 72099-4933 Ph: (501) 987-7319 | Mr Paul A Blake Iv, DO (AS OF 5/31/2020) 1090 Arnold Dr, Little Rock Afb, AR 72099-4933 Ph: (501) 987-7319 |
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