Organization
NEUROLOGY ASSOCIATES OF FORT WORTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROGER S BLAIR MD (OWNER)
(817) 332-2876
Entity
Organization
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00BR07
BCBS GROUP NUMBER
TX
05
—
095026302
—
TX
01
—
C14514
MEDICARE RR GROUP NUMBER
—
Enumeration date
05/15/2006
Last updated
05/23/2008
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