Individual
DR. RONALD WILLIAM BLAIR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
775 POLE LINE RD W, SUITE 212, TWIN FALLS, ID 83301-5814
(208) 814-8400
(208) 734-3045
Mailing address
PO BOX 587, TWIN FALLS, ID 83303-0587
(208) 811-7400
(208) 814-7491
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
O-488
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
808052500
—
ID
01
—
P00973592
MCRR
ID
Enumeration date
07/20/2006
Last updated
12/09/2014
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