MEDICARE: STEPHEN D BLAIR MD

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	207Q00000X	Family Medicine Physician	J8462	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

General Provider Information

NPI Number	:	1962404244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN D BLAIR MD

Provider Business Mailing Address
First Line	:	100 W DEAN KEETON ST STE 100
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78712-1091
Country	:	US
Telephone Number	:	512-471-4955
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 W LOUIS HENNA BLVD STE 100
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78728-1702
Country	:	US
Telephone Number	:	855-481-8375
Fax Number	:

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	08/15/2023

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