Provider Demographics
NPI:1760834634
Name:BLAIR, JOY
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:BLAIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 HERITAGE LNDG
Mailing Address - Street 2:SUITE 202A
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63303-8489
Mailing Address - Country:US
Mailing Address - Phone:314-552-1604
Mailing Address - Fax:
Practice Address - Street 1:1600 HERITAGE LNDG
Practice Address - Street 2:SUITE 202A
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63303-8489
Practice Address - Country:US
Practice Address - Phone:314-552-1604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor