Basic Information
| Provider Information | |||||||||
| NPI: | 1619065760 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLAIS | ||||||||
| FirstName: | FRANCIS | ||||||||
| MiddleName: | XAVIER | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5109 WEST BROAD STREET | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145442093 | ||||||||
| FaxNumber: | 6145441751 | ||||||||
| Practice Location | |||||||||
| Address1: | 5109 WEST BROAD STREET | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145442093 | ||||||||
| FaxNumber: | 6145441751 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 34002468B | OH | X | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0200X | 34002468B | OH | X | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | 2516334 | 05 | OH | MEDICAID |