Basic Information
| Provider Information | |||||||||
| NPI: | 1831397827 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BLAIR FAMILY MEDICINE PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2203 W LAMPASAS ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | ENNIS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751195471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9728783030 | ||||||||
| FaxNumber: | 9728783031 | ||||||||
| Practice Location | |||||||||
| Address1: | 2203 W LAMPASAS ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | ENNIS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751195644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9728783030 | ||||||||
| FaxNumber: | 9728783031 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2007 | ||||||||
| LastUpdateDate: | 06/17/2008 | ||||||||
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| AuthorizedOfficialLastName: | BLAIR | ||||||||
| AuthorizedOfficialFirstName: | RAYMOND | ||||||||
| AuthorizedOfficialMiddleName: | WESLEY | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9728783030 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | M6051 | TX | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.