Individual
JACK D FAIR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
615 BIENVILLE ST, NATCHITOCHES, LA 71457-5730
(318) 352-6800
(318) 352-6803
Mailing address
615 BIENVILLE ST, NATCHITOCHES, LA 71457-5730
(318) 352-6800
(318) 352-6803
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
202650
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09966
—
LA
Enumeration date
05/25/2007
Last updated
03/31/2010
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