Provider Demographics
NPI:1497784359
Name:ADAIR, SANDRA D (DO)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:D
Last Name:ADAIR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4951 LONG PRAIRIE ROAD, SUITE 120
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028
Mailing Address - Country:US
Mailing Address - Phone:972-691-9190
Mailing Address - Fax:972-691-3841
Practice Address - Street 1:4951 LONG PRAIRIE ROAD, SUITE 120
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028
Practice Address - Country:US
Practice Address - Phone:972-691-9190
Practice Address - Fax:972-691-3841
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3215207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153242601Medicaid
TX153242602Medicaid
TXTXB121963Medicare PIN
TXH66860Medicare UPIN
TX153242602Medicaid
TX8552B8Medicare ID - Type Unspecified
TX153242601Medicaid
TXTXB121960Medicare PIN