Provider Demographics
NPI:1043313257
Name:BLAIR, STEVEN DALE (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:DALE
Last Name:BLAIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:866-681-0736
Mailing Address - Fax:
Practice Address - Street 1:1590 POOLE BLVD
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95993-2607
Practice Address - Country:US
Practice Address - Phone:530-751-1800
Practice Address - Fax:530-751-3901
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA70395207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG75892Medicare UPIN
CA00A703950Medicare ID - Type Unspecified