Fair, Jack D

Fair, Jack D is an sole proprietor health care provider with primary practice located at 615 Bienville St , Natchitoches LA 71457-5730. He recently has 2 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Allopathic & Osteopathic Physicians / Family Medicine. Allopathic & Osteopathic Physicians / Family Medicine is his primary health care specialty. Fair, Jack D can be contacted via phone (318) 352-6800.

Contact Information

Primary practice address
615 Bienville St Natchitoches LA 71457-5730
Phone: (318) 352-6800
Fax: (318) 352-6803
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 202650 Louisiana

Profile Details

NPI number 1568673028
LBN Legal business name Fair, Jack D
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date May 25th, 2007
Last updated Mar 31st, 2010 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1568673028 NPPES
Louisiana MEDICAID 09966

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