Provider Demographics
NPI:1992799225
Name:BLAIR, PATRICIA JO (MD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:JO
Last Name:BLAIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 MASON RIDGE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8509
Mailing Address - Country:US
Mailing Address - Phone:314-273-6481
Mailing Address - Fax:
Practice Address - Street 1:660 MASON RIDGE CENTER DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8509
Practice Address - Country:US
Practice Address - Phone:314-273-6481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036155436207Q00000X
MO2000161368207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205089105Medicaid
H27028Medicare UPIN
MO205089105Medicaid