Provider Demographics
NPI:1356396691
Name:BLAIR, RONALD M (MD PA)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:M
Last Name:BLAIR
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 FOREST LN STE B300
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2510
Mailing Address - Country:US
Mailing Address - Phone:972-284-7770
Mailing Address - Fax:972-284-7780
Practice Address - Street 1:7777 FOREST LN STE B300
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2510
Practice Address - Country:US
Practice Address - Phone:972-284-7770
Practice Address - Fax:972-284-7780
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8971208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133359309Medicaid
TX1225173107OtherGROUP NPI
TX133359309Medicaid