Provider Demographics
NPI:1124027479
Name:BLAIR, MAJOR ELLIOTT JR (MD)
Entity Type:Individual
Prefix:DR
First Name:MAJOR
Middle Name:ELLIOTT
Last Name:BLAIR
Suffix:JR
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:PO BOX 3046
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-0746
Mailing Address - Country:US
Mailing Address - Phone:806-398-3627
Mailing Address - Fax:806-351-7801
Practice Address - Street 1:3501 S SONCY RD STE 104
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-6405
Practice Address - Country:US
Practice Address - Phone:806-398-3627
Practice Address - Fax:806-351-7801
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD203742207X00000X
TXMDG1331207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC13516Medicare UPIN
TX00120TMedicare ID - Type Unspecified