Provider Demographics
NPI:1316128069
Name:DONALD L BLAIR M.D.,P.A.
Entity type:Organization
Organization Name:DONALD L BLAIR M.D.,P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-948-7779
Mailing Address - Street 1:920 E HIGHWAY 67 STE 108
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75137-2713
Mailing Address - Country:US
Mailing Address - Phone:214-948-7779
Mailing Address - Fax:214-948-9977
Practice Address - Street 1:920 E HIGHWAY 67 STE 108
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75137-2713
Practice Address - Country:US
Practice Address - Phone:214-948-7779
Practice Address - Fax:214-948-9977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-23
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159988801Medicaid
TX159988801Medicaid
TXTXB155256Medicare PIN