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General NPI Number Information
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NPI Number | 1326493289
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Entity Type | Individual
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Provider Name | BLAIR FUNK MD
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Gender | Female
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Dates
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Enumeration Date | 04/28/2016
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Last Update Date | 11/03/2025
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Provider Practice Location Address
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Address Line | 21731 N 77TH AVE STE 1300
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City | PEORIA
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State | AZ
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Zip | 85382-2109
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Country | US
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Telephone | 2-338-3264
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Fax | 623-561-3305
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Provider Business Mailing Address
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Address Line | 1525 BUFORD HWY
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City | BUFORD
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State | GA
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Zip | 30518-3665
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Country | US
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Telephone | 770-945-1699
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Fax | 770-945-1698
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD61422193
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2024-01311
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 58464
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 81892
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License Number State | GA
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