1003162892 NPI number — FREDERICK CHARLES LAIR CEAC CAPS.

Table of content: FREDERICK CHARLES LAIR CEAC CAPS. (NPI 1003162892)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003162892 NPI number — FREDERICK CHARLES LAIR CEAC CAPS.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAIR
Provider First Name:
FREDERICK
Provider Middle Name:
CHARLES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CEAC CAPS.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003162892
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2315 SHARPSHIRE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76014-3529
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-832-1002
Provider Business Mailing Address Fax Number:
817-764-6467

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2315 SHARPSHIRE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76014-3529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-832-1002
Provider Business Practice Location Address Fax Number:
817-764-6467
Provider Enumeration Date:
07/30/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171WH0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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