Provider Demographics
NPI:1275606246
Name:BAIR, STEPHEN A (DO)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:A
Last Name:BAIR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2152 S VINEYARD
Mailing Address - Street 2:# 131
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-6871
Mailing Address - Country:US
Mailing Address - Phone:480-820-2533
Mailing Address - Fax:
Practice Address - Street 1:2152 S VINEYARD
Practice Address - Street 2:# 131
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-6871
Practice Address - Country:US
Practice Address - Phone:480-820-2533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1369207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZE44446Medicare UPIN
AZ75544Medicare ID - Type Unspecified
AZ75547Medicare ID - Type UnspecifiedGROUP