Provider Demographics
NPI:1831397827
Name:BLAIR FAMILY MEDICINE PA
Entity type:Organization
Organization Name:BLAIR FAMILY MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:BLAIR
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:972-878-3030
Mailing Address - Street 1:2203 W LAMPASAS ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75119-5471
Mailing Address - Country:US
Mailing Address - Phone:972-878-3030
Mailing Address - Fax:972-878-3031
Practice Address - Street 1:2203 W LAMPASAS ST STE 101
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-5644
Practice Address - Country:US
Practice Address - Phone:972-878-3030
Practice Address - Fax:972-878-3031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6051261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Y619Medicare PIN