Healthcare Provider Details

I. General information

NPI: 1801913991
Provider Name (Legal Business Name): MR. PAUL ANTHONY BLAIR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 S CYPRESS RD
POMPANO BEACH FL
33060-7133
US

IV. Provider business mailing address

7002 NW 40TH PL
CORAL SPRINGS FL
33065-2224
US

V. Phone/Fax

Practice location:
  • Phone: 954-781-7248
  • Fax:
Mailing address:
  • Phone: 786-308-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA1624
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: