Individual
MR. TOMMY LEE FAIR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
200 W TYLER AVE, WEST MEMPHIS, AR 72301-4223
(870) 735-1500
(870) 733-3861
Mailing address
200 W TYLER AVE, WEST MEMPHIS, AR 72301-4223
(870) 735-1500
(870) 733-3861
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
12971
TN
367500000X
Certified Registered Nurse Anesthetist
C00206
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
19795701
—
AR
Enumeration date
04/25/2006
Last updated
11/19/2007
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