Provider Demographics
NPI:1992719389
Name:BLAIR, HERBERT MILTON III (MD)
Entity type:Individual
Prefix:
First Name:HERBERT
Middle Name:MILTON
Last Name:BLAIR
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1560 E SHERMAN BLVD
Mailing Address - Street 2:WEST SHORE PROFESSIONAL BUILDING
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1867
Mailing Address - Country:US
Mailing Address - Phone:231-733-4781
Mailing Address - Fax:231-733-8409
Practice Address - Street 1:1560 E SHERMAN BLVD
Practice Address - Street 2:WEST SHORE PROFESSIONAL BUILDING
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1867
Practice Address - Country:US
Practice Address - Phone:231-733-4781
Practice Address - Fax:231-733-8409
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI0613381207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1061584Medicaid
MIHB028089OtherBCBS STATE LICENSE NUMBER
MI0706133812OtherBCBS
E38199Medicare UPIN
MIHB028089OtherBCBS STATE LICENSE NUMBER