Provider Demographics
NPI:1063519411
Name:BLAIR, DENNIS J (LMLP)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:J
Last Name:BLAIR
Suffix:
Gender:M
Credentials:LMLP
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:IRWIN ARMY COMMUNITY HOSPITAL
Mailing Address - Street 2:600 CAISSON HILL ROAD
Mailing Address - City:FORT RILEY
Mailing Address - State:KS
Mailing Address - Zip Code:66442-5037
Mailing Address - Country:US
Mailing Address - Phone:785-239-7155
Mailing Address - Fax:785-239-7364
Practice Address - Street 1:IRWIN ARMY COMMUNITY HOSPITAL
Practice Address - Street 2:600 CAISSON HILL ROAD
Practice Address - City:FORT RILEY
Practice Address - State:KS
Practice Address - Zip Code:66442-5037
Practice Address - Country:US
Practice Address - Phone:785-239-7155
Practice Address - Fax:785-239-7364
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS843103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)