Healthcare Provider Details

I. General information

NPI: 1417999616
Provider Name (Legal Business Name): GREGORY L. BLAIR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 02/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 S MICKEY MANTLE DR SUITE 325
OKLAHOMA CITY OK
73104-2458
US

IV. Provider business mailing address

PO BOX 268922
OKLAHOMA CITY OK
73126-8922
US

V. Phone/Fax

Practice location:
  • Phone: 405-232-0101
  • Fax: 405-232-0102
Mailing address:
  • Phone: 405-231-3857
  • Fax: 405-272-7977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number19544
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: