Provider Demographics
NPI:1932137148
Name:GREENWOOD, BLAIR (MD)
Entity Type:Individual
Prefix:
First Name:BLAIR
Middle Name:
Last Name:GREENWOOD
Suffix:
Gender:F
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 925
Mailing Address - Street 2:
Mailing Address - City:MAYFLOWER
Mailing Address - State:AR
Mailing Address - Zip Code:72106-0925
Mailing Address - Country:US
Mailing Address - Phone:501-470-7413
Mailing Address - Fax:501-470-7415
Practice Address - Street 1:587 HWY 365
Practice Address - Street 2:
Practice Address - City:MAYFLOWER
Practice Address - State:AR
Practice Address - Zip Code:72106-9570
Practice Address - Country:US
Practice Address - Phone:501-470-7413
Practice Address - Fax:501-470-7415
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE4447207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR043852OtherMEDICARE RURAL HEALTH
AR158193001Medicaid
ARI38320Medicare UPIN
AR5N282Medicare ID - Type Unspecified