Individual
DR. ROGER S BLAIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1325 PENNSYLVANIA AVE, SUITE 700, FORT WORTH, TX 76104-2158
(817) 332-2876
(817) 877-3672
Mailing address
PO BOX 961013, FORT WORTH, TX 76161-0013
(817) 332-2876
(817) 877-3672
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
E0404
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
130017251
MEDICARE RAILROAD
—
05
—
132075601
—
TX
01
—
861551
BCBS
TX
01
—
8K5527
BCBS
TX
Enumeration date
02/20/2006
Last updated
03/24/2011
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