Healthcare Provider Details

I. General information

NPI: 1649226705
Provider Name (Legal Business Name): MARK A BLAIR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3811 E BELL RD STE 309
PHOENIX AZ
85032-2160
US

IV. Provider business mailing address

PO BOX 650886 DEPT. 41958
DALLAS TX
75265
US

V. Phone/Fax

Practice location:
  • Phone: 602-971-0950
  • Fax: 602-992-4971
Mailing address:
  • Phone: 805-919-0094
  • Fax: 480-222-0269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number32353
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: