Provider Demographics
NPI:1780665828
Name:ADAIR, JEFFEREY D (MD)
Entity Type:Individual
Prefix:
First Name:JEFFEREY
Middle Name:D
Last Name:ADAIR
Suffix:
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:PO BOX 837
Mailing Address - Street 2:
Mailing Address - City:HOWE
Mailing Address - State:TX
Mailing Address - Zip Code:75459-0837
Mailing Address - Country:US
Mailing Address - Phone:903-487-2248
Mailing Address - Fax:903-487-2306
Practice Address - Street 1:1455 E BERT KOUNS INDUSTRIAL LOOP STE 314
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5634
Practice Address - Country:US
Practice Address - Phone:318-798-4448
Practice Address - Fax:318-795-4713
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD020437207L00000X
LA020437208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA050089989OtherMEDICARE RAILROAD
TX190072202Medicaid
LA1915815Medicaid
AR181033001Medicaid
LA5R167F699Medicare PIN
LA5R167Medicare PIN
LA5R1677721Medicare ID - Type Unspecified
LA050089989OtherMEDICARE RAILROAD
AR181033001Medicaid
TX190072202Medicaid