Provider Demographics
NPI:1003162892
Name:LAIR, FREDERICK CHARLES (CEAC CAPS)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:CHARLES
Last Name:LAIR
Suffix:
Gender:M
Credentials:CEAC CAPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 SHARPSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-3529
Mailing Address - Country:US
Mailing Address - Phone:817-832-1002
Mailing Address - Fax:817-764-6467
Practice Address - Street 1:2315 SHARPSHIRE LN
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-3529
Practice Address - Country:US
Practice Address - Phone:817-832-1002
Practice Address - Fax:817-764-6467
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications