Provider Demographics
NPI:1871512152
Name:BAIR, BRANT ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRANT
Middle Name:ALLEN
Last Name:BAIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2100 CALLE DE LA VUELTA
Mailing Address - Street 2:SUITE C103
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4742
Mailing Address - Country:US
Mailing Address - Phone:505-982-5014
Mailing Address - Fax:505-982-2687
Practice Address - Street 1:2100 CALLE DE LA VUELTA
Practice Address - Street 2:SUITE C103
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4742
Practice Address - Country:US
Practice Address - Phone:505-982-5014
Practice Address - Fax:505-982-2687
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM2001-10207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NME4069Medicaid
NME4069Medicaid