Provider Demographics
NPI:1033649520
Name:THWAITES, BLAIR (MD)
Entity Type:Individual
Prefix:DR
First Name:BLAIR
Middle Name:
Last Name:THWAITES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:BLAIR
Other - Middle Name:
Other - Last Name:CONARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4407 LANDLEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-5142
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2381 E UNIVERSITY DR STE 50
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-2390
Practice Address - Country:US
Practice Address - Phone:972-987-0458
Practice Address - Fax:877-459-3573
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS3469207Q00000X
TXBP10061104207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine