Provider Demographics
NPI:1447254024
Name:BLAKE, HUGO G (MD)
Entity type:Individual
Prefix:DR
First Name:HUGO
Middle Name:G
Last Name:BLAKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5501 S 77 EXPRESSWAY 77
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-8200
Mailing Address - Country:US
Mailing Address - Phone:956-428-5522
Mailing Address - Fax:956-421-2759
Practice Address - Street 1:2310 N ED CAREY DR
Practice Address - Street 2:1A
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8200
Practice Address - Country:US
Practice Address - Phone:956-428-5522
Practice Address - Fax:956-421-2759
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6997207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1229957Medicaid
TX1229957Medicaid
TX8F0211Medicare ID - Type Unspecified
TX122995705Medicaid
TX891721OtherBLUE CROSS BLUE SHIELD
TX060036084OtherMEDICARE RAILROAD
TX8F0211Medicare PIN