Individual
GORDON R BLAIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNP
Contact information
Practice address
1701 MAIN AVE SW, SUITE A, CULLMAN, AL 35055-5299
(256) 737-0880
Mailing address
PO BOX 870, CULLMAN, AL 35056-0870
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1046758
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1046758
LICENSE NUMBER
AL
Enumeration date
09/24/2006
Last updated
04/18/2008
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