Individual
STEPHEN REAGOR BLAIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
805 SAINT VINCENTS DR, SUITE 430, BIRMINGHAM, AL 35205-1636
(205) 939-1250
(205) 939-1349
Mailing address
805 SAINT VINCENTS DR, SUITE 430, BIRMINGHAM, AL 35205-1636
(205) 939-1250
(205) 939-1349
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
9600
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4005942
AETNA PROVIDER ID
—
01
—
51087303
BLUE CROSS PROVIDER #
AL
01
—
631061517
FEDERAL TAX ID
—
Enumeration date
08/13/2006
Last updated
03/08/2013
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