Healthcare Provider Details

I. General information

NPI: 1447202585
Provider Name (Legal Business Name): JAMES CLAYTON BLAIR III PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 10/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1136 WATER ST STE 111
PORT TOWNSEND WA
98368-6728
US

IV. Provider business mailing address

PO BOX 850
PORT ANGELES WA
98362-0146
US

V. Phone/Fax

Practice location:
  • Phone: 360-531-3989
  • Fax:
Mailing address:
  • Phone: 360-344-3663
  • Fax: 360-344-3664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA100003105
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: