MEDICARE: DR. CHARLES EBENEZER BLAIR PHD, RN, CS

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	364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist	539564	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	NP7054	OTHER	TX	BLUECROSS & BLUESHIELD PR

General Provider Information

NPI Number	:	1144433954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES EBENEZER BLAIR PHD, RN, CS

Provider Business Mailing Address
First Line	:	1120 NASA PKWY 220W
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-3362
Country	:	US
Telephone Number	:	903-312-7268
Fax Number	:	281-331-4197

Provider Business Practice Location Address
First Line	:	1120 NASA PKWY 220W
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-3362
Country	:	US
Telephone Number	:	903-312-7268
Fax Number	:	281-331-4197

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

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	12/30/2015

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