Provider Demographics
NPI:1184325227
Name:SIVESS, BLAIR FRANCES
Entity type:Individual
Prefix:
First Name:BLAIR
Middle Name:FRANCES
Last Name:SIVESS
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 1:4900 MEDICAL DR APT 304
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4325
Mailing Address - Country:US
Mailing Address - Phone:254-537-3736
Mailing Address - Fax:
Practice Address - Street 1:4900 MEDICAL DR APT 304
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4325
Practice Address - Country:US
Practice Address - Phone:254-537-3736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX576434261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health