Basic Information
| Provider Information | |||||||||
| NPI: | 1780665828 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ADAIR | ||||||||
| FirstName: | JEFFEREY | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 837 | ||||||||
| Address2: | |||||||||
| City: | HOWE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 754590837 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9034872248 | ||||||||
| FaxNumber: | 9034872306 | ||||||||
| Practice Location | |||||||||
| Address1: | 1455 E BERT KOUNS INDUSTRIAL LOOP STE 314 | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711055634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3187984448 | ||||||||
| FaxNumber: | 3187954713 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2005 | ||||||||
| LastUpdateDate: | 07/02/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MD020437 | LA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 208VP0014X | 020437 | LA | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 050089989 | 01 | LA | MEDICARE RAILROAD | OTHER | 190072202 | 05 | TX | MEDICAID | 1915815 | 05 | LA | MEDICAID | 181033001 | 05 | AR | MEDICAID |