Provider Demographics
NPI:1134314644
Name:BLAIR, RUSSELL ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:ALLEN
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 1:36001 EUCLID AVE
Mailing Address - Street 2:C19
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-4643
Mailing Address - Country:US
Mailing Address - Phone:440-946-0053
Mailing Address - Fax:440-946-1812
Practice Address - Street 1:36001 EUCLID AVE
Practice Address - Street 2:C19
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-4643
Practice Address - Country:US
Practice Address - Phone:440-946-0053
Practice Address - Fax:440-946-1812
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35.092992207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease