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NPI Code Detail

MEDICARE: DR. MARK BLAIR M.D.

MEDICARE: DR. MARK 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
1208600000XSurgery PhysicianMD34454TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1020053847OTHERTNIND RRMCR #
27201687OTHERTNCIGNA HEALTHCARE
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
44043202OTHERTNBCBS OF TN

General Provider Information

NPI Number : 1508869561
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK BLAIR M.D.
Provider Business Mailing Address
First Line : PO BOX 910
Second Line :
City : TULLAHOMA
State : TN
Zip : 37388-0910
Country : US
Telephone Number : 931-461-1150
Fax Number : 888-498-3372
Provider Business Practice Location Address
First Line : 100 WILLIAM NORTHERN BLVD
Second Line :
City : TULLAHOMA
State : TN
Zip : 37388-4754
Country : US
Telephone Number : 931-461-1150
Fax Number : 888-498-3372
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2005
Last Update Date : 02/15/2023

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