Provider Demographics
NPI:1649236662
Name:BLAIR, F WARD (MD)
Entity Type:Individual
Prefix:
First Name:F WARD
Middle Name:
Last Name:BLAIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:F
Other - Middle Name:WARD
Other - Last Name:BLAIR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:825 N MAIN ST STE 140
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-2100
Mailing Address - Country:US
Mailing Address - Phone:937-762-5000
Mailing Address - Fax:937-762-5009
Practice Address - Street 1:825 N. MAIN ST.
Practice Address - Street 2:SUITE 140
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066
Practice Address - Country:US
Practice Address - Phone:937-762-5000
Practice Address - Fax:937-762-5099
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.073856 B207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2068024Medicaid
OH0840954Medicare PIN
OHH387860Medicare PIN
OH0840956Medicare PIN
OH0840953Medicare PIN
OH0840955Medicare PIN
OHF34495Medicare UPIN
OH0840957Medicare PIN
OH0840951Medicare PIN
080131358Medicare PIN