Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 8653218-1205 | UT |
Y | 2080P0207X | Pediatric Hematology-Oncologist | 8653218-1205 | UT |
NPI | 1265750061 |
---|---|
Provider Name | Douglas Beaty Fair |
First Address | Albany, NY 12208-3303 |
Second Address | Albany, NY 12208-3303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2010 |
Last Update Date | 06/12/2021 |