Provider Demographics
NPI:1124255245
Name:CONKLIN, BLAKE VINCENT (DO)
Entity type:Individual
Prefix:
First Name:BLAKE
Middle Name:VINCENT
Last Name:CONKLIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:330 ARKANSAS ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-1335
Mailing Address - Country:US
Mailing Address - Phone:785-505-2200
Mailing Address - Fax:785-505-5237
Practice Address - Street 1:330 ARKANSAS ST
Practice Address - Street 2:SUITE 202
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-1335
Practice Address - Country:US
Practice Address - Phone:785-505-2200
Practice Address - Fax:785-505-5237
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2020-12-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS0538349208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery