Individual
MARK M BLAIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2000 PEPPERELL PKWY, OPELIKA, AL 36801-5452
(334) 528-2499
Mailing address
PO BOX 627, AUBURN, AL 36831-0627
(800) 232-5703
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041217895
IL
367500000X
Certified Registered Nurse Anesthetist
1-094483
AL
367500000X
Certified Registered Nurse Anesthetist
Primary
209001203
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
039441
CRNA RECERTIFICATION
AL
01
—
1-094483
RN & CRNA LICENSE
AL
01
—
209001203
CRNA LIC
IL
Enumeration date
06/01/2006
Last updated
05/02/2018
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