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General NPI Number Information
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NPI Number | 1972590172
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Entity Type | Organization
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Legal Business Name | MARK BLAIR MD PC
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Dates
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Enumeration Date | 10/03/2005
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Last Update Date | 02/15/2023
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Provider Practice Location Address
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Address Line | 100 WILLIAM NORTHERN BLVD
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City | TULLAHOMA
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State | TN
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Zip | 37388-4754
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Country | US
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Telephone | 931-461-1150
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Fax | 888-498-3372
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Provider Business Mailing Address
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Address Line | PO BOX 910
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City | TULLAHOMA
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State | TN
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Zip | 37388-0910
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Country | US
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Telephone | 931-461-1150
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Fax | 888-498-3372
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK BLAIR
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Credential | MD
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Telephone | 931-461-1150
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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 |
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License Number State |
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