Basic Information
| Provider Information | |||||||||
| NPI: | 1649236662 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLAIR | ||||||||
| FirstName: | F WARD | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | BLAIR | ||||||||
| OtherFirstName: | F | ||||||||
| OtherMiddleName: | WARD | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 825 N MAIN ST STE 140 | ||||||||
| Address2: | |||||||||
| City: | SPRINGBORO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450662100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9377625000 | ||||||||
| FaxNumber: | 9377625009 | ||||||||
| Practice Location | |||||||||
| Address1: | 825 N. MAIN ST. | ||||||||
| Address2: | SUITE 140 | ||||||||
| City: | SPRINGBORO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9377625000 | ||||||||
| FaxNumber: | 9377625099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 11/20/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35.073856 B | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2068024 | 05 | OH | MEDICAID |