Provider Demographics
NPI:1053308049
Name:BAIR, BRUCE (PA-C)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:
Last Name:BAIR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 LONG SHADOW PL
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-8639
Mailing Address - Country:US
Mailing Address - Phone:919-632-9589
Mailing Address - Fax:
Practice Address - Street 1:1728 FORDHAM BLVD
Practice Address - Street 2:151 RAMS PLAZA
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514
Practice Address - Country:US
Practice Address - Phone:919-968-1985
Practice Address - Fax:919-942-0038
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100385363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
R19143Medicare UPIN