MEDICARE: DR. DAVID JEFFREY MAIR MD

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	2084P0800X	Psychiatry Physician	36629	IA
2	2084P0800X	Psychiatry Physician	50908	MN

General Provider Information

NPI Number	:	1083655898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID JEFFREY MAIR MD

Provider Business Mailing Address
First Line	:	2021 E HENNEPIN AVE
Second Line	:	STE 330
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55413-2700
Country	:	US
Telephone Number	:	612-435-7200
Fax Number	:	612-435-7201

Provider Business Practice Location Address
First Line	:	2021 E HENNEPIN AVE
Second Line	:	STE 330
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55413-2700
Country	:	US
Telephone Number	:	612-435-7200
Fax Number	:	612-435-7201

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

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	12/11/2014

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