Basic Information
| Provider Information | |||||||||
| NPI: | 1356396691 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLAIR | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7777 FOREST LN STE B300 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752302510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722847770 | ||||||||
| FaxNumber: | 9722847780 | ||||||||
| Practice Location | |||||||||
| Address1: | 7777 FOREST LN STE B300 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752302510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9722847770 | ||||||||
| FaxNumber: | 9722847780 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 03/24/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | H8971 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 133359309 | 05 | TX | MEDICAID | 1225173107 | 01 | TX | GROUP NPI | OTHER |