Basic Information
| Provider Information | |||||||||
| NPI: | 1437461878 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLAIR | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | LEWIS | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 S FARMERVILLE ST | ||||||||
| Address2: | |||||||||
| City: | RUSTON | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712705941 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8504754500 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1200 S FARMERVILLE ST | ||||||||
| Address2: | |||||||||
| City: | RUSTON | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712705941 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182553690 | ||||||||
| FaxNumber: | 3182516388 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2010 | ||||||||
| LastUpdateDate: | 06/11/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | DO.000444 | LA | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.