Healthcare Provider Details

I. General information

NPI: 1689808255
Provider Name (Legal Business Name): CARALEE R. BLAIR D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2009
Last Update Date: 05/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

496 SOUTHLAND DR
LEXINGTON KY
40503-1827
US

IV. Provider business mailing address

496 SOUTHLAND DR
LEXINGTON KY
40503-1827
US

V. Phone/Fax

Practice location:
  • Phone: 859-288-2425
  • Fax: 859-721-3918
Mailing address:
  • Phone: 859-288-2425
  • Fax: 859-288-7510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number03454
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: