Provider Demographics
NPI:1093743114
Name:BLAIR, TIMOTHY JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JAMES
Last Name:BLAIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:701 BROAD STREET
Mailing Address - Street 2:SUITE 2 P.O. BOX 7
Mailing Address - City:KEOSAUQUA
Mailing Address - State:IA
Mailing Address - Zip Code:52565
Mailing Address - Country:US
Mailing Address - Phone:319-293-7771
Mailing Address - Fax:866-894-9687
Practice Address - Street 1:701 BROAD STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:KEOSAUQUA
Practice Address - State:IA
Practice Address - Zip Code:52565
Practice Address - Country:US
Practice Address - Phone:319-293-7771
Practice Address - Fax:866-894-9687
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA27840207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine