Individual
DR. MOTT PARKS BLAIR IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
125 RIVER VINE PKWY, WALLACE, NC 28466-2377
(910) 285-2134
(910) 285-3380
Mailing address
404 E MAIN ST, WALLACE, NC 28466-2726
(910) 285-2134
(910) 285-3380
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
38496
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16113
BLUE CROSS BLUE SHEILD
NC
01
—
561711105
TAX ID
NC
05
—
8916113
—
NC
Enumeration date
12/28/2005
Last updated
01/13/2022
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