Provider Demographics
NPI:1972034841
Name:BLAIR, DAVID RANDALL (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RANDALL
Last Name:BLAIR
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 16TH ST # 706
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94158-2545
Mailing Address - Country:US
Mailing Address - Phone:415-476-5001
Mailing Address - Fax:
Practice Address - Street 1:550 16TH ST # 706
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94158-2545
Practice Address - Country:US
Practice Address - Phone:415-476-5001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-23
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA159073207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)