Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 11537 | WV |
NPI | 1821199647 |
---|---|
Provider Name | Dr. Paul Alex Blair |
First Address | Hurricane, WV 25526-9658 |
Second Address | Hurricane, WV 25526-9658 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 03/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A72592 | (02) | WV |