Provider Demographics
NPI:1043221989
Name:BLAIR, DONALD LEVESTER II (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:LEVESTER
Last Name:BLAIR
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 W WHEATLAND RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-3401
Mailing Address - Country:US
Mailing Address - Phone:214-948-7779
Mailing Address - Fax:214-948-9977
Practice Address - Street 1:3920 W WHEATLAND RD
Practice Address - Street 2:SUITE 108
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3401
Practice Address - Country:US
Practice Address - Phone:214-948-7779
Practice Address - Fax:214-948-9977
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4171207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8658N0OtherBCBS PROVIDER
TX8658N0OtherBCBS PROVIDER