Provider Demographics
NPI:1790824720
Name:FAIR, JOANNA (MD, PH D)
Entity Type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:
Last Name:FAIR
Suffix:
Gender:F
Credentials:MD, PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 BRADBURY DR SE
Mailing Address - Street 2:SUITE 2222
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4374
Mailing Address - Country:US
Mailing Address - Phone:505-272-3120
Mailing Address - Fax:505-272-8060
Practice Address - Street 1:2211 LOMAS BLVD. NE
Practice Address - Street 2:UNM HOSPITAL
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106
Practice Address - Country:US
Practice Address - Phone:505-272-0011
Practice Address - Fax:505-272-5821
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2003-02992085R0202X
NMMD2008-08012085R0202X, 207U00000X
MO2008014000207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine