Individual
JERRY R BLAIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., PH.D.
Contact information
Practice address
3600 AMRON CT, COLUMBIA, MO 65202-1918
(573) 874-1616
(573) 875-0300
Mailing address
3600 AMRON CT, COLUMBIA, MO 65202-1918
(573) 874-1616
(573) 875-0300
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
108058
MO
207WX0107X
Retina Specialist (Ophthalmology) Physician
108058
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
207965708
—
MO
01
—
5388
BLUE CROSS BLUE SHIELD
—
Enumeration date
12/02/2005
Last updated
04/10/2017
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