# MR. MICHAEL PR BLAIR

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1487400602
- **Gender:** Man
- **Credential:** FNP-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WE0003X | Emergency Registered Nurse | N-45980 | ID | — |
| 207Q00000X | Family Medicine Physician | 1361873 | ID | Yes |

## Other

- **Enumeration date:** 04/29/2024
- **Last updated:** 08/27/2024