Basic Information
Provider Information
NPI: 1003147257
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PEOPLES
FirstName: BLAIR
MiddleName: PHILLIP
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 15820 CANOPY AVE
Address2:  
City: CHINO
State: CA
PostalCode: 917089277
CountryCode: US
TelephoneNumber: 9492935189
FaxNumber:  
Practice Location
Address1: 1300 W 7TH ST
Address2:  
City: SAN PEDRO
State: CA
PostalCode: 907323505
CountryCode: US
TelephoneNumber: 3102412500
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/27/2010
LastUpdateDate: 08/28/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000XA125196CAY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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