Provider Demographics
NPI:1497196216
Name:BOOK, BLAIR MICHAEL (IDC)
Entity Type:Individual
Prefix:MR
First Name:BLAIR
Middle Name:MICHAEL
Last Name:BOOK
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2207 TIMBERBROOK LN
Mailing Address - Street 2:
Mailing Address - City:MIDWAY PARK
Mailing Address - State:NC
Mailing Address - Zip Code:28544-1654
Mailing Address - Country:US
Mailing Address - Phone:619-495-6235
Mailing Address - Fax:
Practice Address - Street 1:2207 TIMBERBROOK LN
Practice Address - Street 2:
Practice Address - City:MIDWAY PARK
Practice Address - State:NC
Practice Address - Zip Code:28544-1654
Practice Address - Country:US
Practice Address - Phone:619-495-6235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman