Provider Demographics
NPI:1861402653
Name:BLAIR, JOSHUA C (MD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:C
Last Name:BLAIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:912 DUPONT RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4602
Mailing Address - Country:US
Mailing Address - Phone:502-297-8555
Mailing Address - Fax:502-297-8551
Practice Address - Street 1:912 DUPONT RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4602
Practice Address - Country:US
Practice Address - Phone:502-297-8555
Practice Address - Fax:502-297-8551
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY45497207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100136320Medicaid
KYK072890Medicare PIN
SCRES000Medicare UPIN