Provider Demographics
NPI:1588678973
Name:BLAIR II, GEORGE ARTHUR (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:ARTHUR
Last Name:BLAIR II
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34490
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-0490
Mailing Address - Country:US
Mailing Address - Phone:310-490-2867
Mailing Address - Fax:310-204-1253
Practice Address - Street 1:2001 S BARRINGTON AVE
Practice Address - Street 2:STE 215
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5385
Practice Address - Country:US
Practice Address - Phone:310-490-2867
Practice Address - Fax:310-204-1253
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC414632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C414630Medicaid
E79809Medicare UPIN
CA00C414630Medicaid