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General NPI Number Information
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NPI Number | 1194815886
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Entity Type | Individual
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Provider Name | ROBERT VAN BLAIR MD
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Gender | Male
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 719 W COKE RD SUITE 1, BLDG 1
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City | WINNSBORO
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State | TX
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Zip | 75494-3011
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Country | US
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Telephone | 903-342-3710
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Fax | 903-342-3709
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Provider Business Mailing Address
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Address Line | PO BOX 69
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City | WINNSBORO
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State | TX
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Zip | 75494-0069
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Country | US
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Telephone | 903-342-3710
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Fax | 903-342-3709
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | H5842
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License Number State | TX
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