Provider Demographics
NPI:1841407608
Name:STOTT, BLAIR T (MD)
Entity Type:Individual
Prefix:DR
First Name:BLAIR
Middle Name:T
Last Name:STOTT
Suffix:
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 68952
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-0952
Mailing Address - Country:US
Mailing Address - Phone:317-871-8261
Mailing Address - Fax:317-870-0499
Practice Address - Street 1:801 N STATE ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-1270
Practice Address - Country:US
Practice Address - Phone:317-871-8261
Practice Address - Fax:317-870-0499
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01063771A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200866660Medicaid
IN000000545802OtherANTHEM
INP00659861OtherRAILROAD MEDICARE
IN000000545802OtherANTHEM