Provider Demographics
NPI:1780924555
Name:TIM BLAIR MD PLLC
Entity type:Organization
Organization Name:TIM BLAIR MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:319-293-7771
Mailing Address - Street 1:PO BOX 7
Mailing Address - Street 2:701 BROAD STREET SUITE 2
Mailing Address - City:KEOSAUQUA
Mailing Address - State:IA
Mailing Address - Zip Code:52565-8374
Mailing Address - Country:US
Mailing Address - Phone:319-293-7771
Mailing Address - Fax:866-894-9687
Practice Address - Street 1:701 BROAD STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:KEOSAUQUA
Practice Address - State:IA
Practice Address - Zip Code:52565-8374
Practice Address - Country:US
Practice Address - Phone:319-293-7771
Practice Address - Fax:866-894-9687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-15
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA27840207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty