Provider Demographics
NPI:1720275282
Name:BLAIR, LATINA (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MS
First Name:LATINA
Middle Name:
Last Name:BLAIR
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 GREENWAY PLZ
Mailing Address - Street 2:SUITE 2950
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77046-0905
Mailing Address - Country:US
Mailing Address - Phone:713-335-1754
Mailing Address - Fax:713-358-4870
Practice Address - Street 1:9 GREENWAY PLZ
Practice Address - Street 2:SUITE 2950
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77046-0905
Practice Address - Country:US
Practice Address - Phone:713-335-1754
Practice Address - Fax:713-358-4870
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03060363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP85424Medicare UPIN
TX8L16106Medicare PIN
TX8L16107Medicare PIN