Healthcare Provider Details

I. General information

NPI: 1821199647
Provider Name (Legal Business Name): PAUL ALEX BLAIR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 12/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3667 TEAYS VALLEY RD
HURRICANE WV
25526-9658
US

IV. Provider business mailing address

3667 TEAYS VALLEY RD
HURRICANE WV
25526-9658
US

V. Phone/Fax

Practice location:
  • Phone: 304-201-3223
  • Fax: 304-201-6555
Mailing address:
  • Phone: 304-201-3223
  • Fax: 304-201-6555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number11537
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: