Individual
DR. BENNY FAIR JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
2700 LAFAYETTE ST, SUITE 120, FORT WAYNE, IN 46806-1100
(260) 458-9953
(260) 458-9238
Mailing address
2700 LAFAYETTE ST, STE 100, FORT WAYNE, IN 46806-1100
(260) 458-9953
(260) 458-9238
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
07000728
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000331259
BLUE CROSS
—
05
—
100082090A
—
IN
01
—
P00128864
RR MEDICARE
—
Enumeration date
09/06/2006
Last updated
01/02/2025
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