=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073598785
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEFAN RENE ADAIR M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/14/2005
-----------------------------------------------------
Last Update Date | 07/27/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2677 S. TAMIAMI TRAIL UNIT 3
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-955-5600
-----------------------------------------------------
Fax | 941-870-8489
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2677 S. TAMIAMI TRAIL UNIT 3
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-955-5600
-----------------------------------------------------
Fax | 941-870-8489
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208200000X
-----------------------------------------------------
Taxonomy Name | Plastic Surgery Physician
-----------------------------------------------------
License Number | ME87985
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------