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NPI Code Detail

MEDICARE: DR. DAVID WILSON BLAIR PH.D.

MEDICARE: DR. DAVID WILSON BLAIR PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist111113-2501UT

General Provider Information

NPI Number : 1407934755
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID WILSON BLAIR PH.D.
Provider Business Mailing Address
First Line : 2079 SIERRA DR
Second Line :
City : ELKO
State : NV
Zip : 89801-4557
Country : US
Telephone Number : 775-777-7887
Fax Number :
Provider Business Practice Location Address
First Line : 515 SHOSHONE CIR
Second Line :
City : ELKO
State : NV
Zip : 89801-5072
Country : US
Telephone Number : 775-738-2252
Fax Number : 775-778-3303
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2006
Last Update Date : 07/09/2007

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