MEDICARE: DR. KENNETH AARON MAIR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	J1541	TX
2	207R00000X	Internal Medicine Physician	J1541	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	0045BY	OTHER	TX	BCBS TEXAS/ MEDICARE GROUP #
4	88820F	OTHER	TX	BCBS TEXAS/ MEDICARE INDIVIDUAL #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588696678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH AARON MAIR M.D.

Provider Business Mailing Address
First Line	:	2000 COOPER ST STE 560
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2528
Country	:	US
Telephone Number	:	817-820-2890
Fax Number	:	817-810-0725

Provider Business Practice Location Address
First Line	:	2000 COOPER ST STE 120
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2535
Country	:	US
Telephone Number	:	817-820-2890
Fax Number	:	817-810-0725

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	11/05/2025

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Directions to “ DR. KENNETH AARON MAIR M.D.” Practice Location

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