Healthcare Provider Details

I. General information

NPI: 1649236662
Provider Name (Legal Business Name): F WARD BLAIR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: F WARD BLAIR MD

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 N. MAIN ST. SUITE 140
SPRINGBORO OH
45066
US

IV. Provider business mailing address

825 N MAIN ST STE 140
SPRINGBORO OH
45066-2100
US

V. Phone/Fax

Practice location:
  • Phone: 937-762-5000
  • Fax: 937-762-5099
Mailing address:
  • Phone: 937-762-5000
  • Fax: 937-762-5009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.073856 B
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: