Provider Demographics
NPI:1063476463
Name:FAIR, ROGERS PRESSLEY JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGERS
Middle Name:PRESSLEY
Last Name:FAIR
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 WEST COLORADO BLVD
Mailing Address - Street 2:PAVILION II SUITE 730
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208
Mailing Address - Country:US
Mailing Address - Phone:214-941-5200
Mailing Address - Fax:214-948-8870
Practice Address - Street 1:221 WEST COLORADO BLVD
Practice Address - Street 2:PAVILION II SUITE 730
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208
Practice Address - Country:US
Practice Address - Phone:214-941-5200
Practice Address - Fax:214-948-8870
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8633207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB48480Medicare UPIN