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Deactivated NPI 1720097223 Deactivated / Inactive NPI Male Practitioner

Terry William Blake , PA-C

Physician Assistant • Longview, TX

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Terry Blake has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date August 05, 2006
NPI Deactivation Date September 06, 2023
Total Practice Duration ~17 Years of Practice (2006 – 2023)

Professional Overview & Biography Verified Profile Summary

Terry Blake, PA-C was a registered Physician Assistant practicing in Longview, TX. Throughout an active medical career spanning 17 years, Terry Blake provided care at the practice location at 2901 N 4TH ST until profile deactivation on 2023-09-06.

Practice Location & Contact Primary Location

Practice Address

2901 N 4th St
Emergency Department

Longview, TX 756055128

Telephone 9032323675
Fax 9032423369
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Physician Assistant in Longview, TX

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 18.4 Yrs
State Avg: 13.9 Yrs
Regional Practice Density
49 Specialists

Practicing in Longview, TX (11140 Statewide)

Telehealth Adoption Rate
16.3% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Physician Assistant Primary Specialty

NUCC Taxonomy Code: 363A00000X

State License TX PA01384

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

4 Associated Practitioners
Dr. Rhiana Ireland , MD

Emergency Medicine

NPI 1013115104

Doctor of Medicine (M.D.)

Dr. Harold Taylor , MD

Emergency Medicine

NPI 1043340870

Doctor of Medicine (M.D.)

Matthew Dawson

Nurse Practitioner - Family

NPI 1043820632
Dr. Gene Kelly , MD

Emergency Medicine

NPI 1114069895

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated September 06, 2023

Record deactivated on September 06, 2023

NPI Profile Active August 26, 2014

NPI status registered as active in NPPES database

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Updated Practice Location August 26, 2014

Registered at 2901 N 4TH ST, EMERGENCY DEPARTMENT, LONGVIEW, TX 756055128 (Tel: 9032323675)

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Updated Business Mailing Address August 26, 2014

Registered at PO BOX 847176, DALLAS, TX 752847176 (Tel: 9032371800)

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Provider Name / Credentials Updated August 26, 2014

Recorded as TERRY BLAKE, PA-C

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Medical Taxonomy / Specialty Registered (Primary Specialty) August 26, 2014

Physician Assistant (License #PA01384 in TX)

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Initial NPI Registration & Enumeration August 05, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1720097223
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: August 05, 2006
Last Update: August 26, 2014
Deactivation Date: September 06, 2023

Mailing Address

Po Box 847176

Dallas, TX 752847176

Phone: 9032371800

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.