MEDICARE: DR. LETRICE BLAIR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	MD163497	OR

General Provider Information

NPI Number	:	1104138452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LETRICE BLAIR M.D.

Provider Business Mailing Address
First Line	:	PO BOX 3096
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97208-3096
Country	:	US
Telephone Number	:	503-466-1668
Fax Number	:

Provider Business Practice Location Address
First Line	:	16144 SE HAPPY VALLEY TOWN CENTER DR STE 210
Second Line	:
City	:	HAPPY VALLEY
State	:	OR
Zip	:	97086-4257
Country	:	US
Telephone Number	:	503-486-7040
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2010
Last Update Date	:	08/29/2025

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