Healthcare Provider Details

I. General information

NPI: 1447258819
Provider Name (Legal Business Name): ROBERT GILLESPIE BLAIR JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 12/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

738 NEWMAN RD
NEW BERN NC
28562-5238
US

IV. Provider business mailing address

738 NEWMAN RD
NEW BERN NC
28562-5238
US

V. Phone/Fax

Practice location:
  • Phone: 252-634-2676
  • Fax: 252-633-3502
Mailing address:
  • Phone: 252-634-2676
  • Fax: 252-633-3502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number16825
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number16825
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: