Provider Demographics
NPI:1932444239
Name:BLAIR, CALLIE ROSE (DO)
Entity type:Individual
Prefix:
First Name:CALLIE
Middle Name:ROSE
Last Name:BLAIR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CALLIE
Other - Middle Name:ROSE
Other - Last Name:RAMSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9850 W ST LUKES DR STE 229
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-7912
Practice Address - Country:US
Practice Address - Phone:208-205-7700
Practice Address - Fax:208-205-7701
Is Sole Proprietor?:No
Enumeration Date:2012-11-28
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID5371185207V00000X
CA20A12240207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology