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NPI Code Detail

MEDICARE: BLAIR TERRY PAC

MEDICARE: BLAIR TERRY PAC
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
1363A00000XPhysician Assistant2922OK

General Provider Information

NPI Number : 1306331921
Entity Type Code : Individual
Provider Name (Legal Business Name) : BLAIR TERRY PAC
Provider Business Mailing Address
First Line : 8100 S WALKER AVE BLDG A
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73139-9475
Country : US
Telephone Number : 405-632-4468
Fax Number : 405-632-0436
Provider Business Practice Location Address
First Line : 8100 S WALKER AVE BLDG A
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73139-9475
Country : US
Telephone Number : 405-632-4468
Fax Number : 405-632-0436
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/26/2018
Last Update Date : 06/02/2026

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Directions to “ BLAIR TERRY PAC” Practice Location

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