Provider Demographics
NPI:1700885746
Name:MCNAIR, ALFRED EARL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:EARL
Last Name:MCNAIR
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3616 HOSPITAL ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39581-4117
Mailing Address - Country:US
Mailing Address - Phone:228-818-5521
Mailing Address - Fax:228-872-2225
Practice Address - Street 1:3890 BIENVILLE BLVD
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-5803
Practice Address - Country:US
Practice Address - Phone:228-872-6291
Practice Address - Fax:228-769-2780
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2017-05-10
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-04-10
Provider Licenses
StateLicense IDTaxonomies
MS08621207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS18123Medicaid
MS18123Medicaid
MS102948318Medicare ID - Type UnspecifiedMEDICARE