Provider Demographics
NPI:1730188434
Name:BAIR, ROBERT DEAN (DO)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DEAN
Last Name:BAIR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8810 HOLLY AVE NE STE F
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-2981
Mailing Address - Country:US
Mailing Address - Phone:505-881-1532
Mailing Address - Fax:505-881-4913
Practice Address - Street 1:8810 HOLLY AVE NE STE F
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87122-2981
Practice Address - Country:US
Practice Address - Phone:505-881-1532
Practice Address - Fax:505-881-4913
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2022-04-04
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
NMA710-80207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NME1002Medicaid
NM2302272Medicare ID - Type Unspecified
NMD43023Medicare UPIN