Provider Demographics
NPI:1780606004
Name:FAIR, JEFFREY HASKELL (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:HASKELL
Last Name:FAIR
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 OLMSTEAD LN
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-4199
Mailing Address - Country:US
Mailing Address - Phone:352-586-1059
Mailing Address - Fax:
Practice Address - Street 1:508 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-3634
Practice Address - Country:US
Practice Address - Phone:910-640-2480
Practice Address - Fax:910-640-2487
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME111974208600000X
TXR42192086S0102X
NC29106208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004578500Medicaid
NC8931062Medicaid
FLFY125ZMedicare PIN
NCE42568Medicare UPIN
FL004578500Medicaid