Gordon R Blair, CRNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

1046758 Issued in AL

Practice address

1701 Main Ave SW
Suite a
Cullman, AL 35055-5299

Phone

(256) 737-0880

NPI assigned

Sep 24, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cardiovascular Associates of North Alabama, P.C.

  • Cardiovascular Disease Physician
  • Birmingham, AL
  • NPI 1295784148
  NPD (past)
• Urgent Care Center, LLC

  • Internal Medicine Physician
  • Cullman, AL
  • NPI 1245274000
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208476800000",
    "number": "1275633893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 870",
            "city": "CULLMAN",
            "state": "AL",
            "postal_code": "350560870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 MAIN AVE SW",
            "address_2": "SUITE A",
            "city": "CULLMAN",
            "state": "AL",
            "postal_code": "350555299",
            "telephone_number": "256-737-0880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAIR",
        "first_name": "GORDON",
        "middle_name": "R",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-24",
        "last_updated": "2008-04-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AL",
            "license": "1046758",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "1046758",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Deborah Dianne Black, MA
• Kristy Terry Black
• Natasha Black, MS
• Stephen Anthony Black, PD
• Warren D Blackburn Jr., M.D.
• Heidi Blair, M.D.
• Katie Blakely
• Traci Blalock
• Casey McCary Bloom, D.M.D.
• Thomas Blubaugh, CRNP

• All providers in Cullman, AL
• Family Nurse Practitioner in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.